tag:blogger.com,1999:blog-39757127202822338112024-03-05T21:03:29.037-08:00California Attorneys Representing Licensed, Regulated And Other ProfessionalsThoughts And Articles From Tracy Green, Attorney At Green and Associates, Who Represents Professionals, Businesses and Individuals In Administrative, Criminal Defense, Regulatory, Health Care and Civil Litigation Matters In CaliforniaGreen and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comBlogger676125tag:blogger.com,1999:blog-3975712720282233811.post-36918417435923305262022-02-18T09:56:00.000-08:002022-02-18T09:56:15.150-08:00Owner of Los Angeles Compounding Pharmacy Sentenced to 30 Months in Federal Health Care Fraud Case<p><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text; white-space: pre-wrap;" xml:lang="EN-US"></span></p><div class="separator" style="clear: both; font-family: "Trebuchet MS", "Trebuchet MS_EmbeddedFont", "Trebuchet MS_MSFontService", sans-serif; font-size: 12pt; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhSrOStIEhKStyhY5azMMJ0hJpH40P59UrZIk2ghGb1yJwEmMB7XaoX3j--28SsR9dkFEGXlq-y_aGoKiqNCzKL2GOaniFOGH3uhRex5ntGQ8lwIKLntkXI_F6weQkmzow6pevSnPSaXzGV9Tah_BMekMpfhupibGIl3RRXzraXLjtdFTb5iV0o_cI1Cg=s1024" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEhSrOStIEhKStyhY5azMMJ0hJpH40P59UrZIk2ghGb1yJwEmMB7XaoX3j--28SsR9dkFEGXlq-y_aGoKiqNCzKL2GOaniFOGH3uhRex5ntGQ8lwIKLntkXI_F6weQkmzow6pevSnPSaXzGV9Tah_BMekMpfhupibGIl3RRXzraXLjtdFTb5iV0o_cI1Cg=s320" width="320" /></a></div><span style="font-family: Trebuchet MS, Trebuchet MS_EmbeddedFont, Trebuchet MS_MSFontService, sans-serif; font-size: 12pt;"><br /></span><span style="font-family: trebuchet; font-size: medium;">Compounding pharmacies have been under intense scrutiny by Medicare, private third-party insurance and workers’ compensation insurance carriers for almost ten years. The criminal cases take so long to investigate and prosecute that there is a significant lag time between the time of operations and prosecution. </span><p></p><p><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text; white-space: pre-wrap;" xml:lang="EN-US">Compounding c</span><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text; white-space: pre-wrap;" xml:lang="EN-US">ases that proceed criminally usually involve aggressive and illegal marketing, medical necessity issues, and violation of pharmacy compounding laws and regulations. A recent case gives insight into a case involving compounding pharmacies where preprinted physician prescription pads, waiving of patients’ copays, and attempts to hide the waiving of copays caused criminal problems.</span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text; white-space: pre-wrap;"> </span></span></p><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{a8d7c0d0-0536-4f95-b87c-f14a20ab2376}{112}" paraid="741574052" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">According to court documents, Fusion Rx Compounding Pharmacy </span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">was a provider of compounded drugs. What are compounded drugs? They are non-FDA approved medications that are supposed to be tailored to the needs of a specific patient when FDA-approved medications do not meet the health needs of patient. The pharmacy obtains a compounding license and combines, mixes or alters two or more drugs. The physician is supposed to prescribe and order the compounded medication and indicate what drugs are to be compounded to make it for that particular patient. </span><span class="NormalTextRun SpellingErrorV2 SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-image: var(--urlSpellingErrorV2,url("data:image/svg+xml;base64,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")); background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">Fusion</span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"> RX was owned by Navid Vahedi, a Los Angeles pharmacist.</span></span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{a8d7c0d0-0536-4f95-b87c-f14a20ab2376}{112}" paraid="741574052" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{b8899d42-36f9-42e1-a81b-0d9ed7aea9c0}{147}" paraid="132119940" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">The prosecution alleged in its charging documents and there were admissions in the plea agreements that pharmacist Mr. Vahedi and Fusion Rx paid millions of dollars in kickback payments through the businesses of two marketers to send prescriptions for compounded drugs to Fusion Rx. It was also alleged that Mr. Vahedi and the of his two marketers provided physicians with preprinted prescription script pads that offered “check-the-box” options on the form to maximize the amount of insurance reimbursement for the compounded drugs. From May 2014 to at least February 2016, it was alleged that Fusion Rx received approximately $14 million in reimbursements on its claims for compounded drug prescriptions.</span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{b8899d42-36f9-42e1-a81b-0d9ed7aea9c0}{147}" paraid="132119940" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span><span style="font-family: trebuchet; font-size: medium;"></span></span></p><a name='more'></a><p></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{5bbcc05f-e6a1-45af-bb3c-a6636fb27cc0}{225}" paraid="2136789463" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">The next part of the allegations regarding kickbacks and illegal marketing related to waiving copayments. This is often done, and health care providers forget that this is considered insurance fraud or a kickback to the patients, or both. As part of its contracts with various insurance networks, the prosecution alleged that Fusion Rx was obligated to collect copayments from patients. It was further alleged that because the copayments might discourage patients from requesting expensive and potentially unnecessary compounded drug prescriptions, Fusion Rx did not collect copayments with any </span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">regularity</span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"> and, in other instances, it provided gift cards to patients to offset the amount of the copayments, according to court documents.</span></span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{5bbcc05f-e6a1-45af-bb3c-a6636fb27cc0}{225}" paraid="2136789463" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{5bbcc05f-e6a1-45af-bb3c-a6636fb27cc0}{228}" paraid="1220107974" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">The proof of criminal intent was using Mr. Vahedi’s actions during an audit. The prosecution alleged that after an audit raised concerns that Fusion Rx’s failure to collect copayments would be discovered, Mr. Vahedi directed Fusion Rx funds to be used to purchase American Express gift cards, which were then used to make copayments for certain prescriptions without the patients’ knowledge. Fusion Rx then submitted claims on these prescriptions to various insurance providers, falsely representing </span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">that those patients</span><span class="NormalTextRun SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"> had paid the required copayments.</span></span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{5bbcc05f-e6a1-45af-bb3c-a6636fb27cc0}{228}" paraid="1220107974" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{b1a3d08a-b541-47da-9eb2-19969562b4bb}{157}" paraid="1490813563" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">What happened in the case? In lieu of a trial, Mr. Vahedi and Fusion Rx both plead guilty. Fusion Rx pleaded guilty in February 2021 to one count of conspiracy to commit health care fraud and payment of illegal remunerations. On January 18, 2022, United States District Judge Christina A. Snyder sentenced Fusion Rx Compounding Pharmacy to five years of probation.</span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{b1a3d08a-b541-47da-9eb2-19969562b4bb}{157}" paraid="1490813563" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{3e5d529b-7629-47c9-8f17-864910d668cc}{26}" paraid="1995926370" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">On February 7, 2022, Judge Christina A. Snyder sentenced Mr. Vahedi to 30 months in federal prison for operating his company Fusion Rx Compounding Pharmacy in an illegal manner by paying illegal kickbacks for patient referrals and fraudulently paying patients’ copayments. She has ordered Vahedi and his company to jointly pay $4,400,525 in restitution.</span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{3e5d529b-7629-47c9-8f17-864910d668cc}{26}" paraid="1995926370" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p></div><div class="OutlineElement Ltr SCXW202917028 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{f95cf558-1368-47e0-a754-789c39e2532d}{86}" paraid="1856105284" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span style="font-family: trebuchet; font-size: medium;"><span class="TextRun SCXW202917028 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-variant-ligatures: none !important; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">One of the factors that probably played into the decision to plea was that the two marketers involved – Joshua Pearson of St. George, Utah, and Joseph Kieffer of Los Angeles – previously pleaded guilty. Judge Snyder sentenced Mr. Kieffer to six months in federal prison and ordered him to pay $1.25 million in restitution. Mr. Pearson was sentenced to three years of probation.</span><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{f95cf558-1368-47e0-a754-789c39e2532d}{86}" paraid="1856105284" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{f95cf558-1368-47e0-a754-789c39e2532d}{86}" paraid="1856105284" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;">Posted by Tracy Green, Attorney</span></span></p><p class="Paragraph SCXW202917028 BCX0" lang="EN-US" paraeid="{f95cf558-1368-47e0-a754-789c39e2532d}{86}" paraid="1856105284" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline; white-space: pre-wrap;" xml:lang="EN-US"><span class="EOP SCXW202917028 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20.5042px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet; font-size: medium;">Green and Associates</span></span></p></div>Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-59782759753986018452021-11-29T13:17:00.007-08:002021-11-29T13:17:38.895-08:00San Joaquin County Doctor Convicted of Prescribing Opioids Without Medical Necessity to Patients in Federal Court<p><span style="font-family: Roboto;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQ916SptxRqKJgz5GQaxUBmv-bw-LCBEcM7XgvcjXzJpeP08eB560fA98NISwspcSUOryT45MyPBi5gM7o-3Gv9vXPYODZX_URlE-aVzxKT4x_LmoEXCaHikB-tGFUi50mpf_QTkQPqik1/s250/oxycontin_art_160_20080506083256.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="250" data-original-width="160" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQ916SptxRqKJgz5GQaxUBmv-bw-LCBEcM7XgvcjXzJpeP08eB560fA98NISwspcSUOryT45MyPBi5gM7o-3Gv9vXPYODZX_URlE-aVzxKT4x_LmoEXCaHikB-tGFUi50mpf_QTkQPqik1/s0/oxycontin_art_160_20080506083256.jpg" width="160" /></a></div><br />The problem with physicians prescribing opioid drugs to patients where there is not a proper medical and prescription history taken, lack of a proper medical examination to confirm the legitimacy of patients' pain complaints, and failure to assess the risk of addiction issues continues. <p></p><p><span style="font-family: Roboto;">On November 19, 2021, </span><span style="font-family: Roboto;">Dr. Edmund Kemprud, age 78,</span><span style="font-family: Roboto;"> was</span><span style="font-family: Roboto;"> convicted in Sacramento federal court of 14 counts of illegally
prescribing opioids and other controlled substances to patients. As is common in these cases, undercover officers went to his office in order to obtain evidence that would substantiate the charges. Usually pain medication patients do not want to testify against their physicians so undercover operations are common. </span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">According to evidence presented at trial, Dr. Kemprud was a physician licensed to practice medicine in California and worked
in several locations around the East Bay and Central Valley. One of the more inflamatory allegations was that one of the offices was in the back room of a nail salon and medi-spa in Tracy, California. </span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">Dr. Kemprud prescribed commonly abused prescription drugs, including Hydrocodone, Alprazolam, and
Oxycodone. The government introduced evidence that certain prescriptions were outside the usual course of professional practice and not for
legitimate medical purpose. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">The government introduced evidence at trial showing that Dr. Kemprud ignored "red flags" which are indications that his patients were addicts or that they
were diverting the drugs </span><span style="font-family: Roboto;">during the undercover patient visits. Dr. Kemprud charged </span><span style="font-family: Roboto;">$79 a visit and the evidence was that he often spent less than five minutes with a
patient and would see 30 patients in less than a day. In family practice, those numbers are not unusual for follow up visits but when prescriptions for serious pain medications are being written -- a more extensive visit is expected.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span></span></p><a name='more'></a><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">There was evidence that several pharmacies were so troubled by Dr. Kemprud’s prescriptions that they instituted companywide policies to block his
prescriptions. In addition, t</span><span style="font-family: Roboto;">rial testimony of undercover
officers established that on 14 occasions between Sept. 6, 2018, and March 13,
2019, Dr. Kemprud prescribed opioids without determining the patients’ medical and
prescription histories, without conducting a proper medical examination,
without confirming the legitimacy of the patients’ complaints, and without
assessing the risk of aberrant drug behavior.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">The California Medical Board has a <a href="https://www.mbc.ca.gov/Resources/Medical-Resources/CURES/Prescribing-Rules.aspx">publication for the guidelines for prescribing controlled substances</a> and any and all providers should be compliant with it before prescribing any controlled substance. In addition, the requirements for CURES reports must also be met.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;"><b>Attorney Commentary</b>: The sentencing of Dr. Kemprud is scheduled on February 14, 2022 and the court will have discretion after consideration of statutory factors and the Federal Sentencing Guidelines. The age of Dr. Kemprud may be a factor but I have seen 78 year old clients receive heavy sentences. Often the federal judges can be older and do not view the fact that someone is in their 70s to be a mitigating factor. </span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">However, I have seen cognitive decline among older physicians who do not retire when they should have and fail to recognize the need for complying with the standard of care of a pain management physician. Times have changed considerably in the last 10 years and ignorance of the changing standards of practice is not a very strong defense.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">When a physician prescribes without medical necessity or by following the standard of care, the protection for prescribing controlled substances provided by the DEA license is taken away. </span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;">Posted by <a href="https://www.greenassoc.com/home" target="_blank">Green and Associates</a></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Roboto;"> </span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p>Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-65761840446708415742021-11-29T11:50:00.001-08:002021-11-29T11:50:39.932-08:00 Case Study: Federal Embezzlement Charges Against California Controller. Top 5 Things to Learn From This Indictment<p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxBP-GhGZsz8O0d0UhDa_7_CBpzdSQJGJJcV9ZBpKVIdpWICp0nYjJnbo2uojvi6b7BO5wmlDr-rUf8g6VP88SGvXzeyglLspr7EMWbBCcylmJZVK8bad_vHHSZSIWHMu3Qt2CNY-xiF4j/s780/embezzlement+2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="360" data-original-width="780" height="148" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxBP-GhGZsz8O0d0UhDa_7_CBpzdSQJGJJcV9ZBpKVIdpWICp0nYjJnbo2uojvi6b7BO5wmlDr-rUf8g6VP88SGvXzeyglLspr7EMWbBCcylmJZVK8bad_vHHSZSIWHMu3Qt2CNY-xiF4j/s320/embezzlement+2.jpg" width="320" /></a></div>As attorneys specializing in white collar crime, we have represented businesses who wanted help in presenting a fraud case to the local police or FBI as well as representing those who have been charged with such offenses. <p></p><p>Recently, a controller for two Southern California companies was charged in a federal grand jury Indictment with embezzling $3 million. After providing you with a summary of the allegations, we will delve into what can we learn from this recent Indictment. </p><p>With respect to this particular case, remember that an Indictment does not mean that the accused is guilty, nor is it proof of guilt since our Constitution provides that the accused is presumed innocent until proven guilty beyond a reasonable doubt.</p><p>On November 18, 2021, a federal grand jury in Santa Ana, California in the Central District returned a 15-count Indictment accusing the former controller, Rosalba Meza, for two Anaheim-based companies, Trilogy Plumbing, Inc. and Matrix Management, LLC, of embezzling more than $3 million by directing the transfer of company funds to bank accounts that she controlled. She is scheduled to be arraigned on the indictment today (November 29) in United States District Court in Santa Ana.</p><p>It is alleged that in February 2019, Ms. Meza told executives in these two companies that they did not have funds to meet payroll obligations but failed to inform the executives that she had been embezzling from the companies. Several months later, while the companies were the subject of an IRS enforcement action because of unpaid payroll taxes, Ms. Meza allegedly told the executives that she did not pay the quarterly payroll taxes because she instead had used those funds to pay employees. </p><p>The Indictment alleges that, once the funds were transferred to her accounts, Ms. Meza used the stolen money to make approximately $292,137 in cash withdrawals at bank branches and more than $1 million in withdrawals at ATMs in the United States and Mexico. Ms. Meza also allegedly wired approximately $870,209 to bank accounts in Mexico owned by a family member and another $250,000 in transfers to other family members and friends. The Indictment also alleges that Ms. Meza filed tax returns for the years 2017 through 2019 that failed to report as income the embezzled funds.</p><p>What can we learn from this Indictment? First, like most other people accused of embezzlement, Ms. Meza does not have any criminal history. Past studies have shown that less than 10 percent of people charged with embezzlement have any prior criminal history. This means that background checks alone will not protect you. </p><p><span></span></p><a name='more'></a>Second, business that have weak or non-standardized financial control systems are the most at risk. Smaller companies and non-profit companies are most at risk. While it seems typical to trust long-term employees who handle finances and accounting, it is critical to have controls. Over 70 percent of embezzlement cases involve employees in finance and accounting. <p></p><p>One of the best controls is having an outside bookkeeper or accountant go over the business’ checks and reconciling the bank account on a monthly basis. The person who is in charge of writing checks and doing the bookkeeping should not be in charge of the reconciliation. It may cost more in administration costs, but in the long run you will be thankful for that extra expense. Another control is to have the mail go to a third party who scans all mail before it goes to the controller or head bookkeeper.</p><p>Third, unlike most crime, a majority of the individuals accused of embezzlement are women. The person most likely to embezzle is a woman over the age of 40 working in finance or accounting. Prior studies show that approximately 57 percent of those accused of embezzlement were women. </p><p>Fourth, the embezzlement occurs over a period of time. In this case, the alleged takings were over two years. The average embezzlement case involves a time period over 3 years. This is another reason why internal and external controls are key since it is easier to catch any irregularities at an early stage.</p><p>Fifth, the motivation of the employees is financial. Cases tend to increase during financially difficult times. In addition, over twenty percent of the cases (especially those involving men) involve those addicted to gambling. Look for any red flags relating to employees who appear to be living more lavish lifestyles. While your employees are generally trustworthy, they are human, and inherently sometimes act out of perceived need, regardless of ethics or reason. It helps both employees and companies to not tempt fate with excellent standardized controls.</p><p>Having represented people accused of embezzlement, there is usually a great deal of remorse. But by the time charges are brought, usually the funds have been spent. Repayment of the funds taken is best for anyone accused of these crimes and helps the victims recover from the financial loss. We have urged anyone we have represented to do all they can to repay even a portion of what has been taken.</p><p>In the past, companies were often embarrassed to report that a key employee had stolen from them. However, those days are changing. In this case, it was not simply general funds that were taken but also the withholding amounts from the employees for their payroll taxes. The audit by the IRS was what led to the discovery of the alleged embezzlement. We urge companies to report any thefts unless there are circumstances that would cause further problems. Each case is different.</p><p>Posted by <a href="https://www.greenassoc.com/white-collar" target="_blank">Green and Associates</a></p><p><br /></p>Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-46512637299844521342021-07-29T12:07:00.003-07:002021-07-29T12:07:22.851-07:00California Rehabilitation Therapy Company With 11 Skilled Nursing Facilities Settles Medicare False Claim Allegations for Alleged Unnecessary or Unreasonable Services<p><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: var(--clrWindowText,WindowText); font-family: "Trebuchet MS", "Trebuchet MS_EmbeddedFont", "Trebuchet MS_MSFontService", sans-serif; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"></span></span></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimr4uXIvL-h2YrkUWfGsjBpuFRpRA9N6X-NZSwjyPOcO0p5-5EXM04yNC9NcKonK5BsNQZfectB1rasYkgC8o4wwi3QLztm650y0HeDNUWsAPWMJcQGn8_ltrGmG-WhsYXMBUSYJVbAUAZ/s265/qui+tam.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="265" data-original-width="260" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimr4uXIvL-h2YrkUWfGsjBpuFRpRA9N6X-NZSwjyPOcO0p5-5EXM04yNC9NcKonK5BsNQZfectB1rasYkgC8o4wwi3QLztm650y0HeDNUWsAPWMJcQGn8_ltrGmG-WhsYXMBUSYJVbAUAZ/w196-h200/qui+tam.jpg" title="Qui Tam Case Involving SNFs" width="196" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="color: #2b00fe;">Qui Tam Case Involving SNFs</span></td></tr></tbody></table><span style="font-family: trebuchet;"><br /></span><div><span style="font-family: trebuchet;">Skilled nursing facilities (SNFs) which offer rehabilitation therapy services have a large number of billing specific rules and regulations. The charting for the SNFs is also demanding on the staff. Issues with charting and following billing rules and regulations can create risks of audits and qui tam or false claim lawsuits for SNFs. A recent case shows how such issues play out. This case was initiated by a "whistleblower" who was a former director of rehab and will get a $360,000 payout as part of the settlement. </span><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; font-family: trebuchet; font-size: 14.6667px; font-variant-ligatures: none; margin: 0px; padding: 0px; user-select: text;">The qui tam case is captioned </span><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; font-family: trebuchet; font-size: 14.6667px; font-variant-ligatures: none; margin: 0px; padding: 0px; user-select: text;"><i>United States ex rel. Pennetti v. Interface Rehab, et al</i>.</span><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; font-family: trebuchet; font-size: 14.6667px; font-variant-ligatures: none; margin: 0px; padding: 0px; user-select: text;">, No. CV-14-4133 (C.D. Cal.).</span><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><div style="text-align: left;"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: var(--clrWindowText,WindowText); font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">On or about July 23, 2021, Interface Rehab (Interface), headquartered and operating in Orange County, California agreed to pay $2 million to resolve allegations that it violated the False Claims Act by causing the submission of claims to Medicare for rehabilitation therapy services that were allegedly not reasonable or necessary.</span></span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: var(--clrWindowText,WindowText); font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">The claims resolved by the settlement are allegations only and there has been no determination of liability.</span></span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> <br /></span></span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: var(--clrWindowText,WindowText); font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;">It is very common for these cases to settle since the legal and expert fees alone can cost hundreds of thousands of dollars. Worse, if the case goes to trial and the health care facility loses, the provider can be barred from Medicare. A settlement offers a certain result. However, these cases need to be fought aggressively in order to keep the settlement payments down or to get the cases dismissed if possible. </span></span></div><p><span></span></p><a name='more'></a><p></p><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{73}" paraid="355030328" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">The settlement resolves allegations that for over 7 years (from January 1, 2006 through October 10, 2014), Interface knowingly submitted or caused the submission of false claims for medically unreasonable and unnecessary “Ultra High” levels of rehabilitation therapy for Medicare Part A residents at 11 Skilled Nursing Facilities. These facilities include Colonial Care Center, Covina Rehabilitation Center, Crenshaw Nursing Home, Green Acres Lodge, Imperial Care Center, Laurel Convalescent Hospital, Live Oak Rehabilitation Center, Longwood Manor Convalescent Hospital, Monterey Care Center, San Gabriel Convalescent Center, and Whittier Pacific Care Center.</span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{73}" paraid="355030328" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;"><br /></span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{80}" paraid="67789570" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">This case arose out of another case involving Longwood Management Corporation. In July 2020, the Department of Justice </span><a class="Hyperlink SCXW166369249 BCX0" href="https://www.justice.gov/opa/pr/twenty-seven-skilled-nursing-facilities-controlled-longwood-management-corporation-pay-167" rel="noreferrer noopener" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; text-decoration-line: none; user-select: text;" target="_blank"><span class="TextRun Underlined SCXW166369249 BCX0" data-contrast="none" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: #0563c1; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; text-decoration-line: underline; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" data-ccp-charstyle="Hyperlink" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">announced</span></span></a><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"> </span><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">that Longwood Management Corporation and 27 affiliated skilled nursing facilities agreed to pay $16.7 million to the United States to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary. The settlement announced today resolves Interface’s role in that alleged conduct.</span></span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{80}" paraid="67789570" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;"><br /></span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{98}" paraid="564803180" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">During the relevant time period, Medicare reimbursed skilled nursing facilities at a daily rate that reflected the skilled therapy and nursing needs of qualifying patients. The greater the patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities was for “Ultra High” therapy patients, who required a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech therapy), one of which had to be provided five days a week.</span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{98}" paraid="564803180" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;"><br /></span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{105}" paraid="1664163306" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">The United States contends that Interface pressured therapists to increase the amount of therapy provided to patients in order to meet pre-planned targets for Medicare revenue. These alleged targets could only be achieved by billing for a high percentage of patients at the “Ultra High” level without regard to patients’ individualized needs.</span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{105}" paraid="1664163306" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;"><br /></span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{112}" paraid="1022450675" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">The government argued that the claims that patients required ultra-high levels of care appeared to be driven by a plan to send ultra-high bills to Medicare. The government has asserted that in the future, it will be aggressive in its auditing and review of SNFs who provide r</span><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US">ehabilitation therapy. </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{112}" paraid="1022450675" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span style="font-family: trebuchet;"><br /></span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{140}" paraid="336448581" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;">This civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Keith Pennetti, a former Director of Rehab at Interface. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2 SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-image: var(--urlContextualSpellingAndGrammarErrorV2,url("data:image/svg+xml;base64,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")); background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">Mr. Pennetti,</span><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"> will receive $360,000 of the settlement proceeds. </span></span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{140}" paraid="336448581" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{147}" paraid="814427800" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span style="font-family: trebuchet;"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"> These cases involve a number of departments. In this case, the resolution was a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Central District of California with assistance from the U.S. Department of Health and Human Services Office of Inspector General and the Defense Criminal Investigative Service.</span><span class="EOP SCXW166369249 BCX0" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;"> </span></span></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{147}" paraid="814427800" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><br /></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{147}" paraid="814427800" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US">Posted by Tracy Green, Esq.</p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{147}" paraid="814427800" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><a href="https://www.greenassoc.com/compliance">Green and Associates, Attorneys at Law</a></p><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{147}" paraid="814427800" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><br /></p></div><div class="OutlineElement Ltr BCX0 SCXW166369249" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-size: 12px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;"><p class="Paragraph ParagraphLite SCXW166369249 BCX0" lang="EN-US" paraeid="{d7255e97-f6d1-4134-a521-060bdbd8d204}{168}" paraid="75446744" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: var(--clrWindowText,WindowText); font-kerning: none; margin: 0px; overflow-wrap: break-word; padding: 0px; user-select: text; vertical-align: baseline;" xml:lang="EN-US"><span class="TextRun SCXW166369249 BCX0" data-contrast="auto" lang="EN-US" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-size: 11pt; font-variant-ligatures: none !important; line-height: 18.3458px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-US"><span class="NormalTextRun SCXW166369249 BCX0" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; margin: 0px; padding: 0px; user-select: text;"><span style="font-family: trebuchet;"> </span></span></span></p></div></div></div>Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-61235130068906797992020-02-14T10:24:00.001-08:002020-02-14T10:24:45.474-08:00Sacramento Man Pleads Guilty to Medicare Kickback Scheme Involving Hospices and Home Health Agencies<br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Home health agencies are routinely investigated for kickbacks and a recent case involves cash kickbacks by an insider who was discharging patients. What providers fail to remember is that if there is an illegal kickback, that the entire claim is treated as a false claim even if it was performed and was medically necessary. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On February 6, 2020, Jai Vijay of Sacramento, pleaded guilty to conspiring with
the owners of home health care agencies and a hospice agency to pay and receive
illegal kickbacks in exchange for Medicare beneficiary referrals.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">According
to court documents, Jai Vijay’s wife, Anita Vijay, worked as the social
services director at a skilled nursing and assisted living facility in
Sacramento. In her role, Anita Vijay assisted Medicare beneficiaries in
selecting home health care and hospice agencies following their discharge from
the facility. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Anita Vijay used her position to steer Medicare beneficiaries to
home health agencies in Folsom and El Dorado Hills and a hospice agency in
Folsom. In exchange for the beneficiary referrals, the agencies’ owners paid
Jai Vijay and Anita Vijay illegal cash kickbacks.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">In
his plea agreement, Jai Vijay admitted that the agencies’ owners paid him and
his wife kickbacks in exchange for the referral of approximately 60
beneficiaries. Medicare paid the agencies approximately $400,000 for services
they purportedly provided to the beneficiaries. Because the agencies obtained
the beneficiary referrals by paying kickbacks, they should not have received
any reimbursement from Medicare.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms", sans-serif; font-size: 12pt;">U.S.
District Judge Troy Nunley is scheduled to sentence Jai Vijay on April 30. He
faces a maximum statutory penalty of five years in prison and a fine of
$250,000 or twice the gross loss or gain. The actual sentence, however, will be
determined at the discretion of the court after consideration of any applicable
statutory factors and the Federal Sentencing Guidelines, which take into
account a number of variables.</span></div>
<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-71101861447107241092020-02-10T12:00:00.000-08:002020-02-10T12:00:43.367-08:00Four Indicted in California for Billing Compound Cream Prescriptions to TRICARE and Labor Union Health Plans<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEichkaE5rDpcSG48K1LNrG75m51jma5TmeOkuxlAj724UivCd8VpJVuNCUIw04ZhcT7AJGPF3K8fC26grXPwQJxK7zZE7Xy_-Khpqa8dzVB88UsuxEbaXCwWP3hxZbuHuzl8_OM_yk55_aR/s1600/2188031638_893bd625fa_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="171" data-original-width="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEichkaE5rDpcSG48K1LNrG75m51jma5TmeOkuxlAj724UivCd8VpJVuNCUIw04ZhcT7AJGPF3K8fC26grXPwQJxK7zZE7Xy_-Khpqa8dzVB88UsuxEbaXCwWP3hxZbuHuzl8_OM_yk55_aR/s1600/2188031638_893bd625fa_m.jpg" /></a></div>
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<span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The government has been investigating pharmacies that dispense and bill compound creams for the past 5 years as well as the marketing companies that work with them. Much of the focus has been on billings to workers' compensation carriers or billing to TRICARE, military health insurance, and billing to union health plans.</span></div>
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<span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On February 4, 2020, a </span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 16px;">48-count grand jury indictment </span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">was unsealed naming four defendants relating to an Orange County
compound pharmacy, </span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Professional Compounding Pharmacy (PCP),</span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> that allegedly submitted fraudulent bills to the military’s TRICARE
health plan and a labor union health plan for medically unnecessary compound
cream prescriptions in which there was alleged illegal marketing. An indictment is not evidence and all defendants are</span><span style="background-color: transparent; font-family: "Trebuchet MS", sans-serif; font-size: 16px;"> presumed innocent until and unless proven guilty beyond a reasonable doubt. </span></div>
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<span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The indictment – which contains charges of health care fraud, mail fraud,
illegal kickbacks and money laundering – alleges that </span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 16px;">PCP</span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">, its marketers and
a physician fraudulently generated prescriptions for custom-made compound cream
medications. The indictment alleges that some bills charged </span><span style="color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">as $15,000 per tube.</span></div>
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in Lawndale and National City recruited beneficiaries of TRICARE and the
International Longshore and Warehouse Union’s (ILWU) Pacific Maritime
Association Welfare Plan. </span></div>
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to receive treatment by doctors who supposedly were conducting “pain studies”
to evaluate the effectiveness of the compound pain creams. <o:p></o:p></span><span style="background-color: transparent; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The four defendants named in the indictment are:</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">James Nate Bell, the owner of PCP and two medical marketing companies that were allegedly used to funnel kickbacks to PCP marketers;<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Regina Piehl who was affiliated with several companies that allegedly received and paid kickbacks to refer and obtain prescriptions for PCP;<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Dr. Michael Edwards, a physician who allegedly worked with Piehl to set up clinics to study the efficacy of compound creams, but which the government alleges were "prescription mills" that generated profits for PCP and its marketers; and<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Sara Samhat who allegedly worked with Dr. Edwards to route prescriptions to PCP and other companies involved in the arrangement in exchange for receipt of kickbacks from the referral of the prescriptions.<o:p></o:p></span></div>
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<span style="background-color: white; color: #171e24; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">PCP, which operated in La Habra and Brea, allegedly used a network of marketers
and one principal doctor to locate beneficiaries of the TRICARE and ILWU plans.
PCP and its marketers also enlisted the participation of other doctors and a
nurse practitioner to write prescriptions for pain-relief creams, and PCP
ultimately filled prescriptions – including refills – that were allegedly not
medically necessary.</span></div>
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<span style="background-color: transparent; font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The participants allegedly provided the $200 payments to the
“patients” for agreeing to show up at the clinics for the "pain studies" which are alleged to be fake. <o:p></o:p></span><span style="background-color: transparent; font-family: "Trebuchet MS", sans-serif; font-size: 16px;">They also allegedly paid kickbacks to medical marketers and professionals in exchange for generating a large volume of compound prescriptions. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">PCP allegedly paid marketers approximately 50 percent of the payments it received from
TRICARE and ILWU Plan manager to provide the marketers with ongoing incentives
to find doctors and patients willing to write or accept the compound cream prescriptions which were also allegedly medically unnecessary. Health
care professionals work at these “pain clinics” were allegedly encouraged to write prescriptions for medically unnecessary compounded creams. <o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">The indictment alleges that the alleged illegal business peaked in the first half
2015 and continued into 2016 and then dropped when the reimbursement rates for compounded creams were lowered.</span></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">The alleged losses are high as the indictment alleges that </span></span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">TRICARE sustained losses of approximately $19 million and the ILWU Plan sustained additional losses of approximately $3 million. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">As part of the indictment, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">federal agents obtained warrants to
seize a Cadillac Escalade and two of Bell’s brokerage accounts.</span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-76143071924629760652020-02-10T11:28:00.000-08:002020-02-10T11:28:04.337-08:00California Doctor Who Bought Pacific Hospital in Long Beach Sentenced to 15 Months in Prison for Allowing Continuance of Kickback Arrangements<br />
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<span style="font-size: 14pt;"><span style="font-family: "trebuchet ms" , sans-serif;">On January 17, 2020, </span></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 18.6667px;">Dr. Faustino Bernadett, a physician who is also </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 14pt;">the former owner of Pacific Hospital in Long Beach hospital
was sentenced to 15 months in federal prison for "misprision of a felony." That is a fancy word for saying that he knew of an illegal act and did not stop it.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 14pt;">Dr. Bernadett's case arose out of him continuing the kickback arrangements in existence when he bought Pacific Hospital. He was </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 14pt;">ordered him to pay a $60,000 fine
on top of $1 million he has already forfeited to the United States.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 14.0pt;">Dr. Bernadett, a board-certified anesthesiologist and pain management physician who
retired his license last year, pleaded guilty last year to a one-count criminal
information charging him with misprision of a felony.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 18.6667px;">In 2005, Dr. Bernadett purchased Pacific Hospital from </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 18.6667px;">Michael D. Drobot</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 18.6667px;">. Under the terms of the sale, Mr. Drobot guaranteed to Dr. Bernadett that 75 spinal surgeries per month would be performed at Pacific Hospital or else Mr. Drobot’s payout would be reduced by $25,000 for each surgery below that requirement.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 14.0pt;">Pacific Hospital specialized in surgeries, especially spinal and orthopedic procedures. Pacific
Hospital’s owner, Michael D. Drobot, who is already serving a sentence for conspiring with doctors, chiropractors and
marketers to pay kickbacks in return for the referral of thousands of patients
to Pacific Hospital for spinal surgeries and other medical services paid for
primarily through the California workers’ compensation system.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 14.0pt;">Dr. Bernadett, who became directly involved with the hospital’s day-to-day
operations by late 2007, later learned that Mr. Drobot was making illegal kickback
payments to physicians in order to cause those physicians to steer spinal
surgeries to Pacific Hospital. By January 2008, Mr. Bernadett had learned that Mr. Drobot concealed the illegal kickback payments by entering into various types
of sham contracts – such as management agreements, collection agreements and
option agreements to disguise the kickbacks.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 14.0pt;">The government alleged that instead of putting a halt to Drobot’s kickback scheme, Dr. Bernadett authorized the
continued use of these sham contracts to incentivize surgical referrals to
his hospital. Between January 2008 and October 2010 (when Dr. Bernadett sold his
interest in Pacific Hospital back to Drobot), Pacific Hospital and related
entities made more than $30 million in illicit payments to kickback recipients
and performed approximately 1,400 kickback-induced spinal fusion surgeries.<o:p></o:p></span><br />
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<span style="font-size: 14pt;"><span style="font-family: trebuchet ms, sans-serif;">Out of Pacific Hospital, 24</span></span><span style="font-family: "trebuchet ms", sans-serif; font-size: 14pt;"> defendants have been charged in connection with the scheme, and 15
of them have been convicted, including Drobot and his son.</span><br />
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<span style="font-family: "trebuchet ms", sans-serif; font-size: 14pt;">Posted by Tracy Green, Esq.</span><br />
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-69907957227439500702020-01-09T11:03:00.002-08:002020-01-09T11:03:50.597-08:00Former California Physician Sentenced to 2 Years in Federal Prison for Defrauding Medicare by Prescribing Unnecessary Home Health Services for Kickbacks and Illegally Prescribing Opioid Drugs<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0NbPVeFuvdKAn2Kz89JmmWK5kGstkpw5w5DkO6bTOo4_oJua72wCYzEHGu_R9anvQb7CpJTODgNDdlo0qX70fWGcUwVzPHesi3kCwAN5MI5xjq0dbnUw-4zhTPJZxFeC4L7SwvsevdOgv/s1600/HomeHealthLogoFINAL2011.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="563" data-original-width="1009" height="111" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0NbPVeFuvdKAn2Kz89JmmWK5kGstkpw5w5DkO6bTOo4_oJua72wCYzEHGu_R9anvQb7CpJTODgNDdlo0qX70fWGcUwVzPHesi3kCwAN5MI5xjq0dbnUw-4zhTPJZxFeC4L7SwvsevdOgv/s200/HomeHealthLogoFINAL2011.JPG" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Physicians who order home health where it is not medically necessary can be charged with Medicare fraud. If that same physician orders medications, especially controlled substances, without seeing the patient on a regular basis, that can be another ground for a fraud charge. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The loss amounts can be huge since the physician will be held responsible for the total amount of billings by the home health agency and the pharmacy's prescriptions. A recent case illustrates a physician who ordered home health in exchange for payments and then also prescribed some pain medications that were medically unnecessary. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On January 6, 2020, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Kain Kumar, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">a former doctor, was sentenced to 24 months in federal
prison after having </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">pleaded guilty in April 2019 to one count of health care fraud and one count of distribution of hydrocodone. Mr. Kumar </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">practiced internal medicine, maintained medical offices in Palmdale, Rosamond, and Ridgecrest, California and surrendered his medical license last year.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">He was sentenced by U.S. District Judge Philip
S. Gutierrez. Mr. Kumar was also ordered to pay financial penalties totaling more
than $1 million, consisting of $509,365 in restitution, $494,900 in asset
forfeiture, and a $72,000 fine.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">In the plea agreement, Mr. Kumar admitted that f</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">rom February 2011 until May 2016, he defrauded the Medicare health care
benefit program by prescribing unnecessary home health services in exchange for
the payment of illegal kickbacks to him from a La Verne-based home health agency
called Star Home Health Resources, Inc. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According to the indictment in this
case, Medicare allegedly paid $4,398,599 to Star based on the illegal kickback-tainted
referrals from Mr. Kumar which is greater than the restitution amount ordered which is one of the benefits of entering a guilty plea where the facts are damaging since the sentencing guidelines vary depending on the restitution loss amount. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">In the plea, Mr. Kumar admitted that he </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">caused false and fraudulent claims for
reimbursement to be submitted to Medicare for Medicare beneficiaries that he
did not personally examine or for patients he only briefly examined. Mr. Kumar admitted that he also
prescribed drugs that were not medically necessary and which were paid for by
the Medicare Part D program.</span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">In addition, Mr. Kumar admitted in his plea agreement that between February 2013
and January 2016, that he – without a legitimate medical purpose – prescribed
23,826 pills of the opioid drug hydrocodone (commonly sold under the brand name
Vicodin or Norco) and 38,459 pills of the muscle-relaxer carisoprodol (sold
under the brand name Soma). </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Mr. Kumar admitted that he directed his office staff – who were not
medical professionals – to issue prescriptions for these drugs to patients even
though Mr. Kumar had not examined the patients. Mr. Kumar admitted that he directed his office staff to
sign his name on prescriptions for opioid drugs and also provided his staff
with pre-signed prescriptions. In one instance, although Mr. Kumar examined a
patient only once on the patient’s very first visit, and thereafter he caused
prescriptions to be issued to the patient for hydrocodone and carisoprodol on a
monthly basis for approximately a year and a half even though Mr. Kumar did not
actually see the patient for any subsequent physician examination.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">This case is the fifth one involving Star Home Health. Previously, E</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">laine C. Lat, Star’s chief operating officer and the case’s lead
defendant, was sentenced to </span><a href="https://www.justice.gov/usao-cdca/pr/manager-home-health-agency-sentenced-30-months-federal-prison-paying-illegal-kickbacks" style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">a 30-month prison sentence</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> after pleading
guilty in May 2017 to one count of conspiracy and four counts of paying illegal
kickbacks. Three other defendants, including Ms. Lat’s parents, each pleaded guilty
to criminal charges and were also sentenced in this matter.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><b>Attorney Commentary:</b> Physicians need to be very careful in ordering home health for patients. If it is deemed not medically necessary, the physician can be liable civilly or criminally for <a href="https://www.greenassoc.com/white-collar/health-care-fraud.html" target="_blank">health care fraud</a>. If the physician is paid anything by the home health agency, then the home health billing is automatically deemed a false claim. Home health agencies approach physicians and offer them medical directorships or other sham arrangements in order to hide the kickbacks but that approach can often lead the physician into legal issues. Home health agencies see other businesses offering the same type of arrangements and assume that it must be kosher, but it is generally not. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Any compensation arrangements between a physcian and home health should be reviewed by an experience attorney and there should be an opinion letter issued on the matter where all the facts have been disclosed to the attorney. Comments to the physician such as "we will expect 5 or 6 referrals a month" should immediately raise a red flag.</span></div>
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<a href="https://www.greenassoc.com/home" target="_blank">Posted by Green and Associates</a></div>
Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-73056209800588592982019-12-24T09:04:00.002-08:002019-12-24T09:04:31.221-08:00Happy Holidays, Merry Christmas and Happy 2020!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMkFSZbm4ZfXPzly-PIiC4ryXeDdVSy32XBkvFtzFLGPrVdz-pIr-pzAAIjHPTUub914sy8PdnD4cOW9Y-wTQH_wQ5as_6U8FcLaNmsmcDLW33-Dkc-svWDi88S673n377HfZIhYQSNGZs/s1600/lawyer+christmas.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="541" data-original-width="768" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMkFSZbm4ZfXPzly-PIiC4ryXeDdVSy32XBkvFtzFLGPrVdz-pIr-pzAAIjHPTUub914sy8PdnD4cOW9Y-wTQH_wQ5as_6U8FcLaNmsmcDLW33-Dkc-svWDi88S673n377HfZIhYQSNGZs/s400/lawyer+christmas.jpg" width="400" /></a></div>
<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-30947152166962199742019-12-16T12:51:00.001-08:002019-12-16T12:51:12.510-08:00Recent Case Shows Investigation and Prosecution of Federal Fraud by SSI Recipients Who Travel Outside the U.S. in Excess of 30 Days<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrjfuz4rR_5Iq_aA8Mn725Df3ycH-cRRVqWv-Ja5TMCGQP_Vq2jS_V6YsYZ9xZ_rENYDUTRXULZk53TMLkFDjOntjhwL3OpakFInD-l1Xn4mOMGAXgdU-zNd78D2BPQoLe0eeenWOiJ0DQ/s1600/oig.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="498" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrjfuz4rR_5Iq_aA8Mn725Df3ycH-cRRVqWv-Ja5TMCGQP_Vq2jS_V6YsYZ9xZ_rENYDUTRXULZk53TMLkFDjOntjhwL3OpakFInD-l1Xn4mOMGAXgdU-zNd78D2BPQoLe0eeenWOiJ0DQ/s200/oig.jpg" width="198" /></a></div>
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<span style="font-size: 12pt;"><span style="font-family: Trebuchet MS, sans-serif;">We</span></span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> receive a fair number of calls by people being audited because their parent has been living in a foreign country for months at a time while receiving </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Supplemental Security Income (SSI) from the Social Security Administration (SSA). I have seen an increase in audits by the government, including OIG, for these SSI recipients. This is due to the government's enhanced ability to track federal travel by SSI recipients and a task force. A recent criminal case shows that some of these audits are not just seeking repayment but are filing federal criminal charges.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">On December 11, 2019, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Ahmad Yusuf Nuristani pleaded guilty in federal court to theft of public money, admitting that he received over $100,000 in government
benefits by concealing foreign travel and residency between July 2015 and
December 2018. </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">As a part of his plea agreement, Mr. Nuristani has agreed to make full restitution to the SSA and the California Department of Health Care Services. He will be sentenced before the Hon. Cynthia A. Bashant on March 9, 2020. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">During
a hearing before U.S. Magistrate Judge Karen S. Crawford, Mr. Nuristani admitted
that he applied for SSI from the Social Security
Administration in July 2015. Mr. Nuristani acknowledged that he knew an SSI
recipient must reside within the United States, and that he was required to
report any travel outside of the United States lasting more than thirty
days. Mr. Nuristani admitted to concealing and repeatedly lying to the SSA about his foreign travel and residency, and to
receiving $27,492.44 in SSI payments and to causing a loss of $73,090.34 to the
State of California for health care payments and services as a result of his
fraud. Since SSI recipients automatically qualify for Medi-Cal, this is why there was restitution owed to the State of California.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">The government issued a press release on this case because Mr. Nuristani, age 71, is a former Fulbright Scholar and has been a prominent politician in
Afghanistan for decades. He even served as an Afghan senator even as
he received SSI at his claimed address in El Cajon, California. <o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">This
case was brought through the Travel and Residency Enforcement Co-Op (TREC), a
pilot project of the SSA, its Office of Inspector
General, the California Department of Health Care Services Investigations
Division, and the U.S. Attorney’s Office for the Southern District of
California. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">TREC is designed to detect and prevent misuse of the SSI
program, a needs-based program administered by the SSA and designed to provide a floor of income for the aged, blind or
disabled who have little or no income and resources. An individual
approved to receive SSI automatically becomes eligible to receive Medi-Cal
health benefits from the State of California. Since its formation in
2017, TREC has resulted in 25 federal convictions of individuals who
fraudulently concealed foreign travel, foreign residency, and foreign financial
resources from the SSA. To date, TREC reports it has
obtained over $2 million in court-ordered restitution to state and federal
agencies. <o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;"><b>Attorney Commentary:</b> It is now much easier for the federal and state government to track the foreign travel and length of stay of SSI recipients. I have seen cases where elderly have stayed longer than 30 days due to health issues, but all SSI recipients should be aware of the reporting requirement if there is travel outside the U.S. lasting longer than 30 days. Otherwise, criminal prosecution as well as restitution and fines could be imposed.</span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-27310938567613234382019-12-12T10:39:00.004-08:002019-12-12T10:39:39.258-08:00Northern California Physician Indicted for Prescribing Opioids to Patients Without a Legitimate Medical Need<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0MqkJjA5XYlPL7qTlRR2NMZalsciFH1NBKJNov8qyVzSetYPpgqhI_4JnrY4-9kJXraVYREuMZNaA9GR86xt3qRfaf43moysA29owkKSJ8MhaggUEYWQiGe4Exfotwe19SVUbhGvQ7uUi/s1600/2188031638_893bd625fa_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="171" data-original-width="240" height="142" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0MqkJjA5XYlPL7qTlRR2NMZalsciFH1NBKJNov8qyVzSetYPpgqhI_4JnrY4-9kJXraVYREuMZNaA9GR86xt3qRfaf43moysA29owkKSJ8MhaggUEYWQiGe4Exfotwe19SVUbhGvQ7uUi/s200/2188031638_893bd625fa_m.jpg" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Physicians continue to face charges for prescribing opioids to patients without a legitimate medical purpose. This is one area where physicians and advanced practitioners must exercise extreme caution. A recent case shows that federal charges will be filed in these cases.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On December 5, 2019, a federal grand jury brought a 14-count indictment against physician Dr. Edmund Kemprud of San Joaquin County, charging him with prescribing opioids
to patients outside the usual course of professional practice and not for
legitimate medical purpose. An indictment is not evidence and the physician is presumed innocent.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According
to the indictment, Dr. Kemprud maintained a medical practice in the California cities of Dublin and Tracy. The indictment alleges that on 14
occasions between September 6, 2018 and March 13, 2019, Dr. Kemprud allegedly
prescribed highly addictive, commonly abused prescription drugs, including
Hydrocodone, Alprazolam, and Oxycodone – outside the usual course of
professional practice and not for legitimate medical purpose. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">In these type of cases, the DEA or investigating agency usually uses undercover patients in order to establish the proof to file such charges. </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Dr. Kemprud pleaded not guilty at his arraignment.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><b>Attorney Commentary: </b>Physicians, Osteopaths and advanced practitioners should review the <a href="https://www.mbc.ca.gov/Licensees/Prescribing/Pain_Guidelines.pdf" target="_blank">Medical Board's published pain guidelines</a>. It's a 90 page guideline published in 2014, and is now considered to establish the standard of care in California. There are also links in the document on topics such as benzodiazapenes (Xanax/Alprazolam) at issue in this case and how to taper patients from them ("<a href="https://www.benzo.org.uk/manual/" target="_blank">the Ashton manual</a>"). There is <a href="https://www.cdc.gov/drugoverdose/training/" target="_blank">free web-based training on prescribing opioids from the CDC</a> that should be reviewed and where a provider can earn free continuing education credits.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><a href="https://www.greenassoc.com/white-collar/white-collar-defense.html" target="_blank">Green and Associates</a></span></div>
<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-78012968580866540382019-12-11T11:37:00.001-08:002019-12-11T11:37:18.269-08:00San Francisco Acupuncturist Pleads Guilty To Health Care Fraud In False Billing for Union Members for Services Not Performed or Inaccurately Billed.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic1ocrwneOIajxNcBGtmzAFbS5Few3kK2BOstGz0Yeg9ps27cyswDWeXQ3Qbjho8c0Kj71_hZub2YJCvRm1AfGFFRr9yumA0T3grBJFc8IZzxf86zvnThAZKrr6_zcbxjRhVQE0kOvRoGD/s1600/fraud+image.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="161" data-original-width="264" height="121" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic1ocrwneOIajxNcBGtmzAFbS5Few3kK2BOstGz0Yeg9ps27cyswDWeXQ3Qbjho8c0Kj71_hZub2YJCvRm1AfGFFRr9yumA0T3grBJFc8IZzxf86zvnThAZKrr6_zcbxjRhVQE0kOvRoGD/s200/fraud+image.jpg" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Federal prosecutors have focused investigations on the billing of labor union members’ health benefit plans especially in places like San Francisco where workers have generous union contracts. A recent case illustrates the types of cases that are being prosecuted.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">December 6, 2019, acupuncturist Haichao Huang pleaded guilty to <a href="https://www.greenassoc.com/white-collar/health-care-fraud.html" target="_blank">health care fraud</a>, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">in violation of 18 U.S.C. § 1347,</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;"> </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">and making false statements relating to health care matters</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">, in violation of 18 U.S.C. § 1035(a)(2),</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> in the
Northern District of California. The guilty plea was accepted by the Honorable
Susan Illston, U.S. District Judge. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According
to the plea agreement, Mr. Huang was a health care provider
who offered acupuncture, physical therapy, massage, and other services to
patients in and around San Francisco. From February
2013 through June 2018, Mr. Huang admitted that he submitted and
caused to be submitted false claims for reimbursement from health care benefit
programs that he knew were not properly payable, including from programs
provided through federal government and labor union healthcare plans. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Mr. Huang's plea admits that he included false and inaccurate billing codes that artificially inflated both the
type of service the patient received and the time he spent with the patient.
The plea agreement gives examples of the ways in which Mr. Huang submitted false
and inaccurate billings for reimbursement. For example, Mr. Huang submitted requests for
reimbursement for acupuncture treatment when, in fact, the patient had received
much shorter periods of treatment, no acupuncture treatment, or no care of any
kind at all. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Mr. Huang also submitted claims for services rendered on days when
patients had not been seen by him at all—including days when Mr. Huang was not in
California. Further, after a patient reached the limit of acupuncture sessions
allowed by the relevant insurance program or plan, Mr. Huang falsely and
inaccurately billed for other types of treatments and services that were not
provided, or billed under a patient’s family member’s health plan who never
received treatment through his practice, in order to continue receiving
improper reimbursements. Where there is billing of the family member's plan after benefits have been exhausted it is usually at the request of the family member but it is still not allowed.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Pursuant to the terms of
his plea agreement, Mr. Huang has agreed to pay restitution in an amount to be set
by the court at the time of sentencing, but in no event less than $807,785.38.
Judge Illston scheduled the sentencing hearing for March 13, 2020. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">In addition
to restitution, Mr.Huang faces a maximum statutory sentence of 10 years in
prison and $250,000 for each violation of 18 U.S.C. § 1347. Further, Mr. Huang faces up to five years in prison and a fine of $250,000 for the
violation of 18 U.S.C. § 1035(a)(2). Imposition of a fine depends on the defendant's ability to pay and finances.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The court also may order additional fines
and additional periods of supervised release at sentencing. However, any
sentence following conviction will be imposed by the court only after
consideration of the U.S. Sentencing Guidelines and the federal statute
governing </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">the
imposition of a sentence, 18 U.S.C. § 3553. Payment of restitution prior to sentencing can help Mr. Huang receive a lower sentence since it will show further acceptance of responsibility. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Posted</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> by Tracy Green</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><a href="https://www.greenassoc.com/white-collar/health-care-fraud.html" target="_blank">Green and Associates</a></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">the imposition of a sentence, 18 U.S.C. § 3553. </span></div>
Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-52931304419133869822019-12-02T10:03:00.003-08:002019-12-02T10:03:31.730-08:00Pittsburgh-area Lab Owner Charged with Paying Kickbacks in Connection with Medicare Claims for Genetic Testing Based on Telemedicine Visits<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBlE9NNVzAPizZmtpGNuvA9GU_fWvRwov12k2mBrn4Eov0M7ofGRdpPVvtdkdHLrvUWbnPsnniNxYhtNhq-qXDK2BRb74e04dQRmL_s_kfnBLbhfBQ1rkLmpf9NpJ3FjPKDiCVZ50t-xw2/s1600/genetic+test.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBlE9NNVzAPizZmtpGNuvA9GU_fWvRwov12k2mBrn4Eov0M7ofGRdpPVvtdkdHLrvUWbnPsnniNxYhtNhq-qXDK2BRb74e04dQRmL_s_kfnBLbhfBQ1rkLmpf9NpJ3FjPKDiCVZ50t-xw2/s200/genetic+test.jpeg" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Genetic testing billed to Medicare, especially where telemedicine is used to generate the lab orders, has been a hot area of investigation by the U.S. Justice Department. A recent case illustrates the type of cases that are being targeted.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On November 26, 2019, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Ravitej Reddy, the alleged owner of</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;"> two testing laboratories—Personalized Genetics, LLC, d/b/a Personalized Genomics (PGL) and Med Health Services Management, LP (MHS) in Pennsylvania</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">, was charged in federal court b</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">y criminal Information with 2 counts of conspiracy to pay and receive kickbacks, 1 count of conspiracy to pay kickbacks, and 1 count of offering and paying kickbacks. A criminal Information is not evidence and a defendant is presumed innocent.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According to the Information's allegations, Mr. Reddy's companies billed </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Medicare for 2 types of genetic testing: cancer genomic testing (CGx) and pharmacogenetic testing (PGx). CGx testing used DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGx testing, however, was not a method of diagnosing whether an individual presently had cancer. PGx testing detected specific genetic variations in genes that impacted the metabolism of certain medications. In other words, PGx testing helped determine, among other things, whether certain medications would be effective if used by a particular patient.</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The Information alleges that from approximately May 2018 to April 2019, Mr. Reddy and a </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">group of business consultants, marketers, operator of a telemedicine entity and others acquired thousands of testing samples from Medicare beneficiaries located throughout the United States, as well as the corresponding prescriptions that PGL and MHS needed to bill Medicare for CGx and PGx testing. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">It is alleged that the marketers used targeted campaigns to induce Medicare beneficiaries to submit CGx and PGx specimens by means of cheek swabs sent to their homes or provided to them at "health fairs" held throughout the United States. Marketers, in turn, were allegedly paid percentage-based kickbacks depending upon the Medicare reimbursements for beneficiaries whose samples they had obtained and submitted to PGL or MHS.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">It is also alleged that the operator of a Florida-based telemedicine entity was paid kickbacks in connection with obtaining CGx and PGx prescriptions from physicians who were contracted by his company to review the beneficiaries’ personal and familial medical histories. It is alleged that these contract physicians authorized testing for greater than 95% of beneficiaries despite the fact that the doctors did not conduct a proper telemedicine visit, were not treating the Medicare beneficiaries for cancer or symptoms of cancer, did not use the test results in the treatment of the beneficiaries, and generally were not qualified to understand and interpret the test results.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According to the Information, Mr. Reddy and the others in the group (his alleged co-conspirators) took advantage of PGL’s and MHS’s physical locations within the Medicare coverage area that offered the highest reimbursement rates in the United States. As alleged, the co-conspirators used PGL and MHS as the billing laboratory despite the fact that the labs did not possess properly validated equipment to conduct any CGx testing on-site and, as such, were forced to send samples for proper testing by a so-called reference laboratory that was located outside of the lucrative coverage area.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">The Information alleges three separate conspiracies involving similar conduct related to the acquisition of CGx and PGx specimens. The first conspiracy, however, allegedly involved billings only through PGL, while the second and third conspiracies involved billings through MHS. According to the Information, Mr. Reddy engaged in the second and third conspiracies with some, but not all, of the same co-conspirators as the first conspiracy, and he pursued these alleged side deals, in part, as a way to increase his share of the profits relative to the PGL-based conspiracy. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Finally, the Information charges one substantive kickback count, alleging that Mr. Reddy paid percentage-based kickbacks to another unrelated marketing entity in connection with the acquisition of PGx and other testing samples between October 2017 and April 2019.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">According to the Information, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Mr. Reddy</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> caused PGL and MHS to submit Medicare claims for CGx and PGx testing that regularly exceeded $12,000 per beneficiary. In total, between May 2018 and April 12, 2019, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Mr. Reddy</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">’s laboratories allegedly billed Medicare more than $127 million for CGx and PGx testing, with reimbursements of approximately $60 million.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><b>Attorney Notes:</b> The physicians who work for these telemedicine companies could face exposure as well. If they are deemed to have written medically unnecessary prescriptions, they can be liable for the billing amounts. When I see health care businesses that bill government and private insurance base their business model on telemedicine prescriptions, I let them know that this is a red flag for compliance issues. Telemedicine can be done properly but when physicians are used who have no relationship with the patient, that is a second red flag. Just because Medicare pays for a year or two does not mean that the practice is compliant.</span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-90251270660495804272019-11-25T08:47:00.002-08:002019-11-25T08:47:58.554-08:00Los Angeles Orthopedic Surgeon Sentenced to 30 Months in Federal Prison for Receiving Kickbacks for Referring Surgeries to Pacific Hospital and Using Medical Hardware From Hospital-Related Entity<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqyjkBtZKeMu7wk4IetO-mblp825mFK7QyWa17K40wQAHCfMrdSxSN1IWENZqP_oLP4JqQ_8V9gwwmOhP5dGuN1VwQaEwRgGpRCCsTEBfkAP0L-DMf89xcLh1cVPxZMLk7dM6_-S3zxxYZ/s1600/Bribe_IS.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="282" data-original-width="425" height="132" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqyjkBtZKeMu7wk4IetO-mblp825mFK7QyWa17K40wQAHCfMrdSxSN1IWENZqP_oLP4JqQ_8V9gwwmOhP5dGuN1VwQaEwRgGpRCCsTEBfkAP0L-DMf89xcLh1cVPxZMLk7dM6_-S3zxxYZ/s200/Bribe_IS.jpg" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On November 22, 2019, </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">an orthopedic surgeon specializing in spinal surgeries,</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"> </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">Dr. Daniel Capen, w</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">as sentenced to 30 months in
federal prison after he pleaded guilty. Dr. Capen </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">pleaded guilty in August 2018 to conspiracy to commit honest services fraud and to soliciting and receiving kickbacks for health care referrals relating to Pacific Hospital and related entities. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">In his plea agreement, he agreed that he </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">received at least $5 million in kickbacks for performing hundreds of
spinal surgeries that were mostly for workers' compensation patients. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">U.S. District Judge Josephine Staton who sentenced Dr. Capen also ordered him to forfeit $5 million to the United States and pay a $500,000 fine. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Dr. Capen is 70 years' old and the sentence appears to have taken into account his age and his acceptance of responsibility for the plea. One reason the sentence is 30 months is due to the total loss related to the kickbacks. When there is an illegal referral fee, the entire bill is considered a false or fraudulent claim. Given the cost of hospital bills for such surgeries, the plea agreement indicated that the illegal referral fees resulted resulted in more than $580 million in
fraudulent bills being submitted, mostly to California’s worker compensation
system.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">This kickback arrangement centered on the now-closed Pacific Hospital in Long Beach, which
specialized in surgeries, especially spinal and orthopedic procedures. Pacific
Hospital’s owner, Michael Drobot who is serving a 5-year sentence for conspiracy and illegal kickbacks, paid kickbacks to doctors, chiropractors and
marketers in return for the referral of thousands of patients
to Pacific Hospital for spinal surgeries and other medical services paid for
primarily through the California workers’ compensation system.</span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Dr. Capen admitted to having received kickbacks for referring surgeries to Pacific Hospital and also
for using medical hardware from a Pacific Hospital-affiliated entity during the
spinal surgeries he performed. Dr. Capen further admitted to having received kickbacks for referring medical
services such as urine and drug testing to Pacific Hospital-affiliated
entities.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">In total, between 1998 and 2013, the plea agreement states that Dr. Capen accounted for approximately $142 million
of Pacific Hospital’s claims to insurers, on which the hospital was paid
approximately $56 million. Capen admitted to receiving at least $5 million in
kickbacks during the course of his crimes.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Seventeen defendants have been charged in connection with Pacific Hospital, and 10 of them have been convicted, including Michael Drobot and his son. Another physician, Dr. Timothy James Hunt was sentenced in late September 2019 to two years in federal prison after he admitted taking illegal kickbacks. In addition, Michael </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Drobot currently
faces <a href="https://www.justice.gov/usao-cdca/pr/convicted-leader-billion-dollar-health-care-scam-plead-guilty-violating-court">additional
federal criminal charges</a> for allegedly violating a court forfeiture
order by illegally selling his luxury cars.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;"><b>Attorney Commentary: </b>The alleged kickbacks were paid in the manner of "management fees" and attorneys for the hospital allegedly signed off on these agreements. It appears that the physicians relied on the hospital's claim that these were legal arrangements and did not have their own lawyers review the arrangements. These arrangements went on for years and that led some physicians to believe that they must be legal since it was widespread. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">This is one of the big issues with health care regulations. Just because "everyone" is doing it does not mean it is legal or compliant. The government only has so many resources and may not target that arrangement but if and when the light shines on that arrangement, it can then blow up like this one did. Many respected physicians got caught up in this arrangement.</span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-62682615096559555092019-11-18T13:14:00.002-08:002019-11-18T13:44:46.945-08:00New Civil Qui Tam Lawsuit Filed Against South Dakota Neurosurgeon and His Physician-Owned Distributorships (PODs) Alleging Kickbacks for Devices Used in Spinal Surgeries<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTgKTd3aNN2ASsiUY2so_pURYoXBsbR4InWmcfUs8GQZC8Zc2UfMbwHVH7DllLzdmqGznt-kjc27h9zff8zlKgYdsMvLB2ddPABfaoBOVDeNNqTqvyJvzNIbsPR5FH5ybMXYY550b5b3oK/s1600/pods.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="350" data-original-width="730" height="153" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTgKTd3aNN2ASsiUY2so_pURYoXBsbR4InWmcfUs8GQZC8Zc2UfMbwHVH7DllLzdmqGznt-kjc27h9zff8zlKgYdsMvLB2ddPABfaoBOVDeNNqTqvyJvzNIbsPR5FH5ybMXYY550b5b3oK/s320/pods.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">2016 Senate Report on PODs</td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">The
issue of physician owned distributorships (PODs) is still an issue with
orthopedic surgeons and neurosurgeons. The Justice Department is still filing <a href="https://www.greenassoc.com/litigation/qui-tam-defense.html" target="_blank">qui tam actions</a> and joining actions filed by whistleblowers. Physicians need to be very careful when forming their own device companies or distributorships. Since <a href="https://oig.hhs.gov/fraud/docs/alertsandbulletins/2013/POD_Special_Fraud_Alert.pdf" target="_blank">2013, OIG has stated that PODs</a> are "inherently suspect" under the federal anti-kickback statute.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Recently, on November 14, 2019, the United States filed a civil qui tam complaint against South Dakota neurosurgeon Wilson Asfora M.D. and his medical device companies Medical Designs
LLC and Sicage LLC. The complaint alleges False Claims Act violations arising from the
alleged payment of kickbacks to Dr. Asfora tied to the devices he used in
spinal surgeries which were purchased from his own distributorships Medical Designs and Sicage. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
Anti‑Kickback Statute prohibits offering or paying anything of value to induce
the referral of items or services covered by Medicare, Medicaid, and other
federal healthcare programs. The government’s civil complaint alleges
that Dr. Asfora, Medical Designs, and Sicage engaged in multiple kickback
schemes designed to pay Dr. Asfora hundreds of thousands of dollars in exchange
for Dr. Asfora using spinal devices distributed by Medical Designs and Sicage
in his spine surgeries. <o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
civil lawsuit also alleges that despite receiving numerous warnings that he was
performing medically unnecessary procedures with the devices in which he had a
financial interest, Dr. Asfora allegedly continued to perform such procedures
while personally profiting from his use of devices sold by Medical Designs and
Sicage. <o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
case is captioned <i>United States ex rel. </i></span><span lang="ES-US" style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;"><i>Bechtold, et al. v. Asfora, et al</i>., No. 4:16-cv-04115-LLP
(D.S.D.). </span><span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
claims asserted against the defendants are allegations only, and there has been
no determination of liability.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The case against Dr. Asfora arose from a different but related qui tam case which the United States resolved in October 2019. This related case was against several hospital </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">entities Sanford Health, Sanford Medical Center, and Sanford Clinic (collectively, Sanford), of Sioux Falls, South Dakota </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">where Dr. Asfora performed surgeries. That lawsuit was brought by two other Sanford neurosurgeons and Sanford ultimately </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">greed to pay $20.25 million to resolve False Claims Act allegations that they knowingly submitted false claims to federal healthcare programs resulting from violations of the Anti-Kickback Statute and medically unnecessary spinal surgeries. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;"><b>Attorney's Commentary: </b>These qui tam lawsuits show an aggressive approach by the Justice Department to seek civil damages where there are inducements given to surgeons who perform surgeries and use implants or devices. The Justice Department decided not to pursue criminal charges but the civil qui tam settlements can have severe consequences on a physician's or hospital's status as a Medicare provider and involve significant fines and penalties. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">How does a hospital or surgery center get involved in this type of qui tam lawsuit? How do physicians put themselves at risk when using devices from their own POD? We see the following problems. First, the hospital or surgery center lets the physician choose the device and the company he or she buys it from without checking the prices of the device and approving it internally. The physician then does not establish why he/she chooses to use their own device and not one of its competitors.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Second, the hospital or surgery center wants to keep the physician happy and does not question the increase in surgeries when the physician has a financial incentive to use his/her own devices. The allegation of "unnecessary" surgeries is one that is very serious to patients' health. On the criminal side, these allegations can be charged as honest services fraud if the conduct fails to notify patients of the conflict of interest. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: 12pt;">Third, the amount of money earned from devices is significantly higher than from surgeries. Physicians are </span>incentivized<span style="font-size: 12pt;"> to create these companies and often their lawyers and accountants do not warn them of the high risks in these PODs. Fourth, one issue is whether these PODs are truly new products that vary from existing products on the market. What new benefitws will the patient receive? </span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: 12pt;">The "everyone does these deals" does not help defend these cases in a civil context. It is true that many POD cases have bene ignored and not prosecuted civilly or criminally. However, where there are two knowledgeable whistleblower physicians, like here, who filed a case in which the U.S. intervenes: there is a significant financial and business problem for the physician and hospitals where the surgeries were performed.</span></span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Posted by Tracy Green, Esq.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><a href="https://www.greenassoc.com/litigation/qui-tam-defense.html" target="_blank">Green and Associates, Attorneys at Law</a></span></div>
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Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-29485383189696170862019-11-09T10:50:00.003-08:002019-11-09T10:50:17.961-08:00Former Merced Health Care Provider CEO Sentenced to 5 Years in Prison for Medi-Cal and Health Care Fraud<span style="font-family: Trebuchet MS, sans-serif;"><a href="https://www.greenassoc.com/white-collar/medicare-medical-fraud.html" target="_blank">Health care fraud prosecutions</a> continue to focus on nonprofit and community health clinics. At times, the community health centers are not run as rigorously as hospitals or larger entities but they are held to the same standard. Non-profits have special rules and founders or executives cannot run them for their own benefit. A recent case shows an aggressive prosecution against the founder and CEO of a nonprofit in California.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA02IYzRzRc-E13gmqEC5N5shTrE2-V7pHiJTuR_YEaOgomXrsOWfoUUydppUR-Zk7X891G2ekv2dsJYK13X3b2YLZ8NcKXSklq1Lhfsx-0nied8OdiLyq-9YyKTrmiq4JhJapzjEScdch/s1600/horisons+unlimited.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="641" data-original-width="1140" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA02IYzRzRc-E13gmqEC5N5shTrE2-V7pHiJTuR_YEaOgomXrsOWfoUUydppUR-Zk7X891G2ekv2dsJYK13X3b2YLZ8NcKXSklq1Lhfsx-0nied8OdiLyq-9YyKTrmiq4JhJapzjEScdch/s320/horisons+unlimited.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photo: mvelez@mercedsunstar.com</td></tr>
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<span style="font-family: Trebuchet MS, sans-serif;">On November 5, 2019, Sandra Haar, 59, of Merced, was sentenced in Fresno by U.S. District Judge O’Neil to five years in prison and ordered to pay $6,107,846 in restitution for health care fraud and conspiracy to receive kickbacks. </span><span style="font-family: "Trebuchet MS", sans-serif;">Ms. Haar was ordered to self-surrender on Jan. 15, 2020, to begin serving her sentence. </span><br />
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<span style="font-family: "Trebuchet MS", sans-serif;">This sentence came after a guilty plea as there was no trial. She had plead guilty in 2018 and as part of the plea agreement her daughter and husband would not be prosecuted. This is often an important part of the plea where other family members have been involved in a business.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Ms. Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services to low-income patients in Merced, San Juaquin Valley, and surrounding communities. </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">According to court documents, between January 1, 2014, and March 2017, Ms. Haar orchestrated a method of billing Medicare and Medi-Cal for services she knew were not reimbursable. For example, Ms. Haar billed Medi‑Cal for health and dental services that were not rendered and for unnecessary health care services.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Some of the more colorful allegations to which Ms. Haar agreed to plead were that she allowed the organization to bill Medi-Cal for office visits with purportedly licensed doctors when the patients instead were dispensed Suboxone, an opioid medication, in the parking lots of McDonald’s and Rite Aid in baggies.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">According to court documents, Ms. Haar personally received thousands of dollars in kickbacks in cash from an account executive at a laboratory in exchange for using it for patients’ laboratory testing.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;"><b>Attorney Commentary:</b> The non-profit community clinics that rely solely on Medi-Cal and Medicare will find that it is very difficult, if not impossible to break even without a foundation or additional support. In addition, non-profits have to be run for the community benefit. Often business people form a non-profit but do not follow the rules regarding conflict of interest, excess benefits and no self-dealing.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">This was a case where the non-profit sued her in a civil lawsuit in 2017 and that is what led to this criminal investigation. </span><span style="font-family: "Trebuchet MS", sans-serif;">In the civil case, she was alleged to have borrowed $758,346 from the nonprofit without Board approval to buy properties for her family. In addition, she added her husband as an employee with an annual salary of $65,000 with no duties and a $50,000 annual pension, again with no Board approval. The financial mismanagement then led to an audit of billing while she was CEO. Finding a kickback arrangement with a laboratory was one of the black and white issues that would lead to criminal charges. </span><br />
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<span style="font-family: "Trebuchet MS", sans-serif;">Posted by: Tracy Green, Esq.</span><br />
<span style="font-family: "Trebuchet MS", sans-serif;">Green and Associates</span><br />
<span style="font-family: "Trebuchet MS", sans-serif;">Email: tgreen@greenassoc.com</span><br />
<span style="font-family: "Trebuchet MS", sans-serif;">Direct Dial: 213-233-2261</span><br />
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-17263669232660729902019-11-08T09:27:00.000-08:002019-11-08T09:27:30.274-08:00Sugar Daddy Website Users: Pay Attention. San Diego Attorney Who Used Site Has Entered Federal Guilty Plea to Enticing and Coercing a Female to Engage in Prostitution.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYZcQDIvMEHxmZt7BMDuIBxNHmYpec19GaqWyI1K2NUzgtM_mBZF_NsdehBlVBbD06Aem6hhuTBu_zfUdUdbrAz53mstyXqv9gobS4DJYzKLkyDIixePF0DhyphenhyphenKRP9XQpvndTxwk_Bb9g3W/s1600/sugar+daddy+website.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="928" data-original-width="1044" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYZcQDIvMEHxmZt7BMDuIBxNHmYpec19GaqWyI1K2NUzgtM_mBZF_NsdehBlVBbD06Aem6hhuTBu_zfUdUdbrAz53mstyXqv9gobS4DJYzKLkyDIixePF0DhyphenhyphenKRP9XQpvndTxwk_Bb9g3W/s200/sugar+daddy+website.jpg" width="200" /></a></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Sugar Daddy websites that offer a </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">“mutually beneficial relationship” are being investigated as part of h</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">uman trafficking when they involve minors and young women. A recent case, has a San Diego attorney pleading guilty which will probably lead to prison time and potential loss of bar license. </span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">I hope this case causes people to think twice about the nature of these websites and how vulnerable young women can be lured to them. Professionals especially should be very careful since they are held to a higher level of conduct. </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">This case did not involve an agent posing as a young woman but an actual minor female who claimed to be 18 year's old but was still in high school. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">On
October 30, 2019, San Diego attorney William David Turley plead guilty in
federal court to enticing and coercing a female to engage in prostitution in
violation of 18 U.S.C. § 2422(a). U.S.D.C., So Dist, CA, Case No. 18-CR-4574-AJB.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">According
to his plea agreement, on or about April 30, 2018, Mr. Turley began
communicating with an adult female victim whom he met on the website
sugardaddymeet.com. Mr. Turley and the victim discussed entering into a
“mutually beneficial relationship,” meaning that Mr. Turley would provide the
victim with financial support and the victim would provide companionship for
and engage in sexual acts with Mr. Turley.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">On
or about May 3, 2018, Mr. Turley persuaded, induced, and enticed the victim to
take a flight from a city in California to Las Vegas, Nevada to meet with him. Mr.
Turley paid for the victim’s flight and other travel expenses. At the time the
victim boarded the flight in California, she understood that she was traveling
to Las Vegas to engage in sexual acts with Mr. Turley in exchange for monetary
compensation. In Las Vegas, Mr. Turley provided the victim with between $1,500
and $1,800 in cash, and Mr. Turley and the victim engaged in sexual
intercourse.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">The
plea agreement also states that on or about May 12, 2018, Mr. Turley began
communicating with the female victim via sugardaddymeet.com. In conversations
with the minor victim, they discussed that she was 18 years old. But he was
aware that she was a high school student, that she could not meet on weekends
because she was grounded, and that her parents had taken her cellphone away due
to poor performance in school.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">On
or about May 15, 2018, the victim walked from her high school across the street
to a library where Mr. Turley was waiting. Mr. Turley took the minor victim to
a Boba tea shop nearby.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">On
or about May 16, 2018, Mr. Turley met the victim at the library after school
and drove her to a store where Turley purchased the minor victim a cellphone. Mr.
Turley then drove the minor victim a short distance, parked the car, and
engaged in a sex act with the minor. The victim told Mr. Turley she wanted to
stop and needed to get home. Mr. Turley gave the minor victim $300.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;"><b>Attorney Commentary: </b>These
are serious cases. I suspect it got the attention of federal authorities when he had the female fly to Las Vegas to meet him. There are women who get lured to Las Vegas in human trafficking and never make it back home. This was not that type of case but there are young women especially those who are in the foster care system, are from disadvantaged homes or who have family disputes during the teen years who fall prey to someone willing to support them. When I say serious, look at the potential sentence. The maximum penalty in this case is twenty (20) years in
prison and a $250,000 fine. </span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">One of the reasons Mr. Turley must have plead is
due to the plea agreement not alleging that she was a minor and to seek
benefits of cooperation and downward departures in sentencing. The San Diego
Human Trafficking Task Force investigated this case.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Presently, Mr. Turley is scheduled to be
sentenced before U.S. District Judge Anthony J. Battaglia on March 2, 2020 at 9
a.m. but this could be continued.<o:p></o:p></span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-12466507279840744812019-11-05T11:13:00.003-08:002019-11-05T11:13:51.234-08:00Prosecutions for Immigration Fraud Are On the Rise: Federal Grand Jury Indicts Lawyer and Accountant in Visa Fraud Conspiracy for South Korean Nationals<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ67gIjLPEmiKqRSbEHQEYA9R_SFVheHpPDIX6pcPwGcSDfVyZBJclSCTK4ZSBBGO-SurN6Eb7D2mF8THm1C32ecuNnw0p4zuRqjLbxxZG2IYScG0UxCfYuIJzkQw4q0omAJBxRTMXLHs8/s1600/eb2+visa.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="254" data-original-width="385" height="131" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ67gIjLPEmiKqRSbEHQEYA9R_SFVheHpPDIX6pcPwGcSDfVyZBJclSCTK4ZSBBGO-SurN6Eb7D2mF8THm1C32ecuNnw0p4zuRqjLbxxZG2IYScG0UxCfYuIJzkQw4q0omAJBxRTMXLHs8/s200/eb2+visa.jpeg" width="200" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">While
federal prosecutions for white collar crime have been cut in half the past
three years, there is an increase in immigration fraud cases in large part due to the current administration's emphasis on preventing illegal immigration. A recent case
illustrates this trend. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On November 4, 2019, in the Central District of
California, an indictment was unsealed charging two men with conspiracy to
commit visa fraud by having a plan to obtain lawful permanent resident (LPR) status
for South Korean nationals by allegedly submitting fraudulent visa applications
that falsely claimed American businesses wanted to hire skilled foreign
workers.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
named defendants are Weon Keuk Lee, a South Korean national who is also a
licensed California attorney who previously operated an immigration law firm in
Los Angeles; and Young Shin Kim, a naturalized United States citizen, who
previously operated an accounting firm in Diamond Bar, California. An
indictment contains allegations that a defendant has committed a crime. Every
defendant is presumed innocent until and unless proven guilty beyond a
reasonable doubt.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
fact that the two defendants are an attorney and accountant is important since
their skill levels are often used to show knowledge of the rules and intent. The
indictment alleges that Mr. Kim and Mr. Lee exploited the EB-2(a) visa program
by submitting falsified Alien Worker Petitions on behalf of companies – some
legitimate, some created specifically for their plans – that purportedly wanted
to hire foreign nationals after exhausting attempts to find suitable workers in
the United States. <o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">According
to court documents, those South Korean visa applicants simply wanted to
immigrate to the United States, and they paid between $30,000 and $70,000 to Mr.
Park and Mr. Kim and their businesses in the hopes of obtaining a visa. It is believed that these South Korean visa applicants are cooperating with federal authorities. <o:p></o:p></span></div>
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<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Mr.
Kim was arrested in this case on October 3 pursuant to a criminal complaint and
the grand jury indictment came afterwards. Mr. Lee is believed to be currently
residing in Vietnam. It is unknown whether extradition will be sought. <o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
detailed allegations in the indictment contend that between 2007 and 2015, Mr. Lee
and Mr. Kim filed approximately 117 fraudulent Alien Worker Petitions with U.S.
Citizenship and Immigration Services, which resulted in the agency issuing more
than 125 visas for alien workers, their spouses and their children.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The
Indictment further alleges that Mr. Lee accepted payment from South Korean
nationals who wanted to obtain EB-2(a) visas that would allow them to live and
work in the United States. Mr. Kim allegedly identified United States
businesses to act as the purported petitioner for the beneficiary, either by
misappropriating information from his accounting firm’s clients or by forming
shell corporations solely for the purpose of petitioning authorities for visas. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The indictment also alleges that Mr. Kim fabricated documents – including false tax returns – for the domestic companies and that Mr. Lee used those documents
to submit the fraudulent Alien Worker Petitions. Mr. Lee allegedly paid Mr. Kim
nearly $300,000 for preparing the fraudulent documents used with the visa
applications.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;"><b>Attorney Commentary:</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">The charge of conspiracy to commit <a href="https://www.greenassoc.com/white-collar/fraud.html" target="_blank">visa fraud</a> carries a statutory maximum sentence of five years in federal prison. This case is being filed in large part to deter others. While the sentences will not long with a first time offender, it could certainly lead to Mr. Lee being deported as it does not appear he is a U.S. citizen. <o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">This
case is part of a joint task force called the “Document Benefit Fraud Task
Force” which includes representatives of the U.S. Department of State’s
Diplomatic Security Service; U.S. Citizenship and Immigration Services, Fraud
Detection National Security Unit; and U.S. Immigration and Customs
Enforcement’s Homeland Security Investigations.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The U.S. current policies on "illegal immigration" are leading to heightened scrutiny of immigrants from other countries through visa applications. Anyone in this business will need to ensure that they are compliant with the laws and regulations or face criminal prosecution.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Posted by Tracy Green, Esq.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;"><a href="https://www.greenassoc.com/white-collar/fraud.html" target="_blank">Green and Associates, Attorneys at Law</a></span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-43940180828812797052019-09-09T11:40:00.000-07:002019-09-09T12:07:12.708-07:00How to Write a Letter to the Court for Sentencing: Felicity Huffman Letter as a Case Study<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOrd38FSXiH8OzjGQYwqrZXT5aK_hwMiC87d1MsVrgqFgJR2FkZgHoLoXTRRs2bphM0Ahre6OyL0_3_ApM-POZCNV0I36zRauJXdwgMAxYeELRRvYNL01fNaFtq6zD4ZTI7vFoan2G4wWc/s1600/singer+bribery.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="613" data-original-width="920" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOrd38FSXiH8OzjGQYwqrZXT5aK_hwMiC87d1MsVrgqFgJR2FkZgHoLoXTRRs2bphM0Ahre6OyL0_3_ApM-POZCNV0I36zRauJXdwgMAxYeELRRvYNL01fNaFtq6zD4ZTI7vFoan2G4wWc/s320/singer+bribery.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Credit: SF Gate</td></tr>
</tbody></table>
<span style="font-family: inherit;">In cases, we have clients and friends, colleagues and family
write character and support letters. These are not easy letters to write. I'll
use the recent letter written by Felicity Huffman as a case study. I view it as
a first draft and think it could have been much improved. </span><br />
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<span style="font-family: inherit;"><span style="color: #14171a;">You can review the letter and see what you think. Here's the
link to: <a href="https://www.amazon.com/clouddrive/share/3i3fRIAaniha1PhZDegNfIOdsTaUHepSxtb1tKlZeXT"><span style="color: blue;">Huffman Letter, page 1</span></a>; <a href="https://www.amazon.com/clouddrive/share/Zug8zz4pgh7HfETFpuyOBcPRqaboV8evOi6dZbgYDLj"><span style="color: blue;">Huffman Letter, Page 2</span></a>; and <span style="color: blue;"><a href="https://www.amazon.com/clouddrive/share/NBAvXIAjbg835fZWeNoTwJTdNr0G7xB0UAFgbFCADCW" target="_blank">Huffman Letter pa<span style="font-family: inherit;">ge 3</span></a></span></span></span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">First, I tell clients when they write such letters that it is hard
to truly apologize at the same time that you're crying for yourself and your
family. The letter came off to me as being more about how this has adversely
affected Ms. Huffman and her family than how she apologizes to the victims of
the SAT cheating fraud and the college students across the country who took the
same test her daughter did. She could have acknowledge in greater detail that
her actions and bribe resulted in her daughter getting an additional 400 points
on the SAT which is a big jump.</span></div>
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<span style="font-family: inherit;"><span style="font-family: inherit;"><br /></span>
</span><span style="font-family: inherit;"><span style="font-family: inherit;"><span style="font-family: inherit;"><span style="font-family: inherit;">Second, I would have told her t</span>hat h</span>er l</span>etter focused in my
opinion too much upon herself and was too self-involved. Her statements that
"I find Motherhood bewildering" and that she was in a "blind
panic" when she decided to pay off the proctor would have been deleted by
my red pen. Her husband's statements in his letter, see below, about how
motherhood was "frightened" his wife did not help.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"></span><br />
<a name='more'></a>Motherhood, especially during stressful college application time,
is not easy for anyone but Ms. Huffman went to top schools including NYU, comes
from an upper class background and has the resources to get help if mothering
is bewildering. In addition, agreeing to pay someone to proctor and fix her
daughter's SAT scores takes time and planning and isn't the type of thing one
does in a "blind panic."<span style="font-family: "trebuchet ms" , sans-serif;"> </span></div>
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<span style="font-family: inherit;"></span></div>
<span style="font-family: inherit;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: inherit;">Third, I would have asked her to spend
time on writing about her understanding that her actions defrauded the College
Board, the Educational Testing Service (ETS) and colleges with the false SAT
score as well as giving her daughter an advantage over thousands of college
students across the country. It also put doubt in the sanctity and fairness of
the college testing and admission process for millions of students and their
families across the country. Some thought "yep, it really is a system
rigged in favor of the wealthy." I would have asked her to think about
what else she could do to help show her remorse for her actions and the big
picture understanding of why so many people were offended by her actions and
this scandal.</span></span><br />
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<span style="font-family: inherit;">Fourth, I would have taken my red pen to
the section of her letter that described how the high school her daughter
attended was "underfunded" with only one college counselor. The way
it is written simply sounds like a way to justify her behavior. Now if she had
donated money to this underfunded school to help low-income students pay for
SAT prep classes or another college counselor, it would have made sense. Or if
she explained that she foolishly justified her actions back then with this
flimsy rationale that she knew was wrong, then keep it in. Otherwise, delete
those comments.</span></div>
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<span style="font-family: inherit;">Fifth, the statements about her
daughters' learning disabilities would have gotten the red pen. It seems like
another way of justifying her wrong and illegal conduct. It also smacks of
filing in a court pleading details about her daughter's developmental delays
and learning disabilities. Again, my red pen would have come out or I would
have asked her to revise by stating in an understated way that her warped
mindset back then was that she used her daughter's struggles with math and
learning challenges to rationalize her conduct.</span></div>
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<span style="font-family: inherit;">Ms. Huffman even outed her other younger
daughter as having learning disabilities to try to show that she had
"reformed" since she decided not to cheat with the younger daughter.
Again, it's too self-involved and reveals private information about her
children that the world doesn't need to know. Such comments could offend a
sentencing judge.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Of course, Ms. Huffman's feelings about
how her own psychological mindset and despair at harming her daughter are
natural, but I guide clients to get out of that mindsight and focus on those
other than oneself and one's family. Most of my client's first draft of these
letters are similarly self-centered. So it's a common issue</span><span style="font-family: inherit;">.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><span style="font-family: "trebuchet ms" , sans-serif;">S</span><span style="font-family: "trebuchet ms" , sans-serif;">ixth, the character letters by her
husband William Macy and her friend Eva Longoria could be much better. How?
They should have spoken about Ms. Huffman's sincere remorse and explain how
andy why she decided to plead guilty early and how she told others to be
careful about taking such misguided and illegal shortcuts for one's children
and family. I've attached links to Mr. Macy's letter here: <a href="https://www.amazon.com/clouddrive/share/m9n1tanSH9I5v02U4zjPY2rVCNvXfIrrr246h7lMPKl" target="_blank">Macy Letter, Page 1</a>; <a href="https://www.amazon.com/clouddrive/share/VJcJBJfZONK5gnUIF5p3LookzsJD15gdeh4GQmVo9rV" target="_blank">Macy Letter, Page 2</a>; <a href="https://www.amazon.com/clouddrive/share/ldI8rHTWq9RM1uTiFBcSqBDnGNCMqywRXcf5eqw1jN1" target="_blank">Macy Letter Page 3</a>; and </span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.amazon.com/clouddrive/share/CNtsserR3oqHUFUndUQ0PmRn9f8Df6lxjkKnZyi7XWi" target="_blank">Macy Letter Page 4</a>. The pink elephant in the Macy letter is how he does not mention that he knew about this planned fraud and did not stop it. </span></span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Her husband's letter focused too much on
how his wife couldn't leave the home due to paparazzi, wanted to be a great mom
and how she helped better his life. His statements that “Motherhood has, from
the very beginning, frightened Felicity and she has not carried being a mom
easily" and "She’s struggled to find a balance between what the
experts say, and her common sense" would have been deleted. An expert
wouldn't say to cheat and I'd certainly hope that wasn't her common sense
speaking.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Mr. Macy's letter was more about how the
offense affected his wife including the loss of auditions and not the
"victims" of the College Board, ETS and other college students. It
smacked a bit too much of she's already been punished enough. Ms. Longoria's
letter was quite nice but also did not address the remorse of her friend --
just how she helped her get paid more as a fledgling actress and was
supportive.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Just too self-centered for my sentencing
character letter preferences. Yes I'll admit that saying "sorry" is a
tricky task. If you don't say you're sorry, then you're criticized. If you say
you're sorry, then the response is "well, sorry doesn't fix it." I
think showing that you have insight, have earned the right to say you're sorry
by your deeds and actions and leaving out how it harmed your own life and your
family's is a good start. Focus on those it wronged. That's my lawyer advice
and it also works at getting people to understand the impact of their actions
on others.</span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-83860762857001991932019-07-04T12:22:00.001-07:002019-07-04T13:27:43.148-07:00Director of California Cosmetic Surgery Center Who Fled Pending Trial Is Returned to U.S. to Face Federal Charges in Health Care Fraud Case For Billing Cosmetic Procedures to Insurance as "Medically Necessary"<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivHmy0cGXFaCJVEOAl4cwLf3I7GB0-1K3J6c1VzbYXfjCWOX2rfJySMcs7fxXPnz_6D8YO0KVymQNaE5Sby3xjS59Ngk4c6j5Q498DoEhsuWB79TAmbXkDtpWeUGTEL0wJTyz5GmFbeQ0S/s1600/morrow+institute.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="417" data-original-width="625" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivHmy0cGXFaCJVEOAl4cwLf3I7GB0-1K3J6c1VzbYXfjCWOX2rfJySMcs7fxXPnz_6D8YO0KVymQNaE5Sby3xjS59Ngk4c6j5Q498DoEhsuWB79TAmbXkDtpWeUGTEL0wJTyz5GmFbeQ0S/s200/morrow+institute.jpg" width="200" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">Extraditions for health care fraud cases are more common now especially where the loss amounts are high. In a recent case, </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">Linda Morrow, </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">a Rancho Mirage woman married to a plastic surgeon, David</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;"> Morrow, who had fled the United States after being </span><a href="https://www.justice.gov/usao-cdca/pr/executive-director-coachella-valley-surgery-center-named-new-indictment-adds-charges-50" style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">named in a 31-count federal grand jury indictment</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;"> in 2016, arrived in Southern California on July 1 after being deported by Israel, which had determined that she had entered that nation on a fraudulent Mexican passport. Ms. Morrow </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">faces federal charges related
to allegations that she fraudulently billed insurance companies $50 million for
“medically necessary” cosmetic surgeries has been returned the United States
after fleeing to Israel two years ago.</span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Ms. Morrow appeared in U.S. District Court in Santa Ana on July 2, 2019 and entered a not guilty plea to a separate grand jury indictment
that charges her with contempt of court for fleeing while free on bond. During
that hearing, she was ordered detained and a trial date in the contempt case
was scheduled for August 27. She will make another court appearance later this
month to discuss the status of the pending health care fraud case.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Ms. Morrow and her husband, David Morrow, were arrested in Israel on June
16. David Morrow, who pleaded guilty in 2016 in the health care fraud case and
was <a href="https://www.justice.gov/usao-cdca/pr/fugitive-coachella-valley-doctor-who-admitted-running-cosmetic-surgery-scam-took-tens">sentenced in
absentia to 20 years in federal prison</a>, is pending extradition
proceedings in Israel. David Morrow also faces contempt of court charges for
fleeing while he was pending sentencing.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: 12pt;">Linda Morrow, who was the executive director of The Morrow Institute (TMI) in
Rancho Mirage, is charged with participating in a scheme to defraud health
insurance companies by submitting bills for more than $50 million for
procedures that were claimed as “medically necessary” – but are alleged to be cosmetic procedures such as “tummy tucks,” “nose jobs,” breast augmentations
and vaginal rejuvenation. The indictment outlines </span>allegations<span style="font-size: 12pt;"> where patients
were lured to TMI with promises that cosmetic procedures would be paid for by
their union or PPO health insurance plans. The indictment further alleges that
some patients who underwent multiple surgeries at TMI suffered severe medical
complications from the procedures.<o:p></o:p></span></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The health insurance companies included Anthem Blue Cross, Blue
Cross/Blue Shield of California, Blue Cross/Blue Shield of Massachusetts,
Regional Employer/Employee Partnership for Benefits, formerly known as
Riverside Employer/Employee Partnership (REEP) and Cigna. When insurance
companies refused to pay for the cosmetic procedures for patients who happened
to be employed by public entities such as school districts, TMI made formal
claims against those public entities, demanding payments totaling more than $15
million from the California Highway Patrol, the Desert Sands Unified School
District, the Palm Springs Unified School District and the City of Palm
Springs.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The indictment naming Linda Morrow with conspiracy, 23 counts of mail fraud,
six identity theft charges, and one count of misprision of a felony for
allegedly failing to report the health care fraud scheme to authorities. If she
were to be convicted, Linda Morrow would face a potential sentence of more than
500 years in federal prison. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">An
indictment contains allegations that a defendant has committed a crime. A
defendant is presumed to be innocent until and unless proven guilty in court.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;"><a href="https://www.greenassoc.com/" target="_blank">Posted by Green and Associates, Attorneys at Law</a></span></div>
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<br />Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-12447906068626271602019-07-03T15:02:00.005-07:002019-07-04T12:01:22.661-07:00West Hollywood Doctor Charged With Health Care Fraud, False Statements and Witness Tampering Relating to Billing Medicare for Human Growth Hormone Serostim and Alleged Buybacks From Patients for Resale<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmS029QR3DoCU3OLJa7bdEt57uxh7fL7EpHkrlARDMt2LGf65OauXtUiclabuQ4sLZRteQd6P8B_yYzReayL-D7daEMUJw0RWzZGQs7jjrAjCLEZcCY8jMXbuVCdyQbHVPmZcHOYlAv4lu/s1600/354767525_c7eeada85f_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="187" data-original-width="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmS029QR3DoCU3OLJa7bdEt57uxh7fL7EpHkrlARDMt2LGf65OauXtUiclabuQ4sLZRteQd6P8B_yYzReayL-D7daEMUJw0RWzZGQs7jjrAjCLEZcCY8jMXbuVCdyQbHVPmZcHOYlAv4lu/s1600/354767525_c7eeada85f_m.jpg" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On July 2, 2019, a doctor James T. Lee, who operated a medical clinic in West Hollywood where
he specialized in treating HIV patients was taken into custody in Vienna, Austria after waiving extradition pursuant to
federal charges that allege he defrauded health insurance companies in connection with the brand-name human growth
hormone Serostim.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">After a federal grand jury returned a 10-count indictment on June 6, Dr. Lee was
arrested in Vienna at the request of the United States. Dr. Lee subsequently waived
extradition and agreed to return to the United States. T</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">he indictment against Dr. Lee charges him with one count of conspiracy to commit
health care fraud, six counts of health care fraud, one count of making false
statements relating to health care matters, and two counts of witness
tampering. Dr. Lee is</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;"> presumed innocent and charges are not evidence.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The indictment has been unsealed and the arraignment was scheduled in downtown Los
Angeles. The government claims that Dr. Lee </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">allegedly engaged in a scheme to divert Serostim – an injectable human
growth hormone that is FDA-approved for HIV-positive patients – from legitimate
HIV patients to other people who purchased the drug for its purported
anti-aging properties. The Food and Drug Administration has approved Serostim
for use only by HIV patients with wasting or cachexia who are also receiving
antiretroviral therapy. </span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">According to the Indictment, from at least May 2011 until February 2019, Dr. Lee
wrote prescriptions for Serostim to HIV patients, who obtained the drugs and
used their Medicare Part D benefits to pay for the drugs. Dr. Lee or those associated with him then illegally
purchased the Sersotim back from patients, so that he could re-sell the
Serostim. Dr. Lee allegedly re-sold the Serostim to other
patients who were not HIV-positive, and who used the human growth hormone to
build muscle and for other cosmetic purposes.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">The indictment alleges a second part of the scheme in which Dr. Lee allegedly
submitted claims to health insurance companies for Serostim injections, claims
that were fraudulent because Dr. Lee did not actually provide the Serostim
injections to the patients at his office. According to the indictment, many of
the patients did not receive the full amount of Serostim that Dr. Lee billed to the
insurance companies, or they received Serostim that Dr. Lee had purchased from
other patients.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Dr. Lee allegedly twice engaged in witness tampering during meetings with a patient
that were recorded without Dr. Lee’s knowledge. During those meetings, Dr. Lee allegedly encouraged the patient to provide false information to federal agents who were
investigating the case. Dr. Lee allegedly coached the patient to lie about the Serostim
scheme, including by falsely stating that kickback payments from Dr. Lee were
merely overpayments from the insurance companies, according to the indictment.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">During the course of the conspiracy, Dr. Lee and his co-conspirators allegedly submitted at
least $14.2 million in claims to the insurance companies for Serostim
injections, which resulted in payments of approximately $5.9 million, according
to the indictment. The scheme allegedly defrauded Health Net, which is a
private health benefit plan, and the Government Employees Hospital Association,
which is a health benefit plan that provides health insurance coverage to
certain former United States government employees.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Medicare allegedly paid at least $1.4 million based on Serostim prescriptions that were
issued by Lee and filled by patients who sold at least some of the drugs to
Lee. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">An
indictment contains allegations that a defendant has committed a crime. Every
defendant is presumed innocent until and unless proven guilty.</span><br />
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Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-22613476506455959722019-06-21T16:46:00.000-07:002019-06-21T16:46:19.524-07:00Orange County Psychiatrist Sentenced to More than Four Years in Federal Prison for Writing Illegal Opioid Prescriptions to Drug Dealer<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0MqkJjA5XYlPL7qTlRR2NMZalsciFH1NBKJNov8qyVzSetYPpgqhI_4JnrY4-9kJXraVYREuMZNaA9GR86xt3qRfaf43moysA29owkKSJ8MhaggUEYWQiGe4Exfotwe19SVUbhGvQ7uUi/s1600/2188031638_893bd625fa_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="171" data-original-width="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0MqkJjA5XYlPL7qTlRR2NMZalsciFH1NBKJNov8qyVzSetYPpgqhI_4JnrY4-9kJXraVYREuMZNaA9GR86xt3qRfaf43moysA29owkKSJ8MhaggUEYWQiGe4Exfotwe19SVUbhGvQ7uUi/s1600/2188031638_893bd625fa_m.jpg" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On June 19, 2019, a psychiatrist who practiced at a Santa Ana clinic was sentenced to 57 months in federal prison for issuing prescriptions for controlled substances, such as oxycodone, hydrocodone, alprazolam and amphetamine salts, to a non-patient in exchange for cash, admitting in his plea agreement that the prescriptions were </span><span style="font-family: "trebuchet ms", sans-serif; font-size: 16px;">without a medical purpose and</span><span style="font-family: "trebuchet ms", sans-serif; font-size: 16px;"> </span><span style="font-family: "trebuchet ms", sans-serif; font-size: 12pt;">he knew the drugs would
be diverted and sold on the street.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Dr. Robert Tinoco Perez was sentenced by Judge Andrew J. Guilford. Dr. Perez
pleaded guilty on February 25, 2019 to one felony count of conspiracy to distribute
controlled substances.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Dr. Perez admitted that he wrote prescriptions for “patients” he had never met or examined,
including an undercover officer. Dr. Perez admitted that he created fictitious medical records
for drug customers to provide justification for their prescriptions.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Dr. Perez also used false patient names to write the fraudulent prescriptions to
co-defendant William Jason Plumley who sold the
prescribed drugs – as well as other illegal non-prescription drugs such as heroin and methamphetamine – to an undercover law
enforcement officer. Mr. Plumley now is serving a 70-month federal prison sentence
for selling prescriptions written by Dr. Perez as well as the drugs filled from Dr. Perez’s prescriptions. Mr. Plumley pleaded guilty in October 2018 to one count of
conspiracy to distribute controlled substances.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Dr. Perez admitted in his plea agreement that between December 2017 and January
2018, he wrote prescriptions for fictitious patients for 240 pills of Adderall,
300 pills of Roxicodone (oxycodone), and 250 pills of Norco (hydrocodone). Dr. Perez sold the prescriptions to Plumley for at least $1,400, according to
Perez’s plea agreement.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">This case is part of "Operation
Hypocritical Oath," a series of investigations led by the Drug Enforcement
Administration targeting medical professionals with criminal charges, search
warrants, and administrative actions that have led to the revocation of DEA
licenses.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Posted by Tracy Green, Esq.</span><br />
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Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-40221109903145355442019-05-31T12:42:00.002-07:002019-05-31T12:58:42.421-07:00Sacramento Man Sentenced to 3 Years in Prison for Causing Misbranded Drugs to Be Sold Online As Weight Loss and Fat Burner Pills<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCu4GshXnohj0Pp-b7mJq5HXQU_2n5k5NnA52UqscV_ODzzIhlHpmF7NY_wtzB_Rf1RQsMHtthDfHE0gd9QIDWEfbS4mXOVlNiJ21ASFUO0kgEEN3INhhyc3fJ4-LW3X2u3P2pR2z8wjiJ/s1600/fda.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCu4GshXnohj0Pp-b7mJq5HXQU_2n5k5NnA52UqscV_ODzzIhlHpmF7NY_wtzB_Rf1RQsMHtthDfHE0gd9QIDWEfbS4mXOVlNiJ21ASFUO0kgEEN3INhhyc3fJ4-LW3X2u3P2pR2z8wjiJ/s320/fda.jpg" width="320" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">The </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">U.S. Food and Drug Administration (FDA) has stepped up criminal enforcement where misbranded drugs are being sold online to consumers. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On May 29, 2019, Scott Edward Cavell of Sacramento was sentenced by U.S.
District Judge John A. Mendez to three years in prison for causing misbranded
drugs to be introduced into interstate commerce for weight loss. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">According
to plea agreement and court documents, between 2015 and 2017, Mr. Cavell, with others, developed a plan to market and sell a drug, 2,4-Dinitrophenol (also known as DNP), as a
weight loss drug and “fat burner” despite knowing that DNP is not approved by
the FDA as a substance for human consumption. Mr. Cavell sold DNP in pill form and
called it a fertilizer — a term under which is it legally sold in other
circumstances.</span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">Mr. Cavell
admitted that he controlled websites that marketed the drug as a supplement
while at the same time discouraging its use. He proceeded to sell DNP pills on
another website, thefertizerwarehouse.com, for the admitted purpose of misleading U.S.
Food and Drug Administration regulators.<o:p></o:p></span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">DNP
has been commercially used to manufacture dyes and wood preservatives, as a
fertilizer, and as a pesticide. The U.S. Food and Drug Administration has
declared that DNP is too toxic to be used for human consumption under any
circumstances.<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;">According
to court documents, Mr. Cavell collected at least $763,000 for compounding this fertilizer into pills for human consumption. </span><br />
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt;"><b>Attorney Commentary: </b></span><span style="font-family: "trebuchet ms", sans-serif; font-size: 12pt;">The online sales of supplements is being monitored by the FDA and FTC and any sellers, resellers or marketers need to be careful to ensure that what is being sold is legal for sale in the U.S. for human consumption and be mindful of any misrepresentations. Importing over the counter pills and products from overseas can also raise issues where there has been no independent testing of them. Countries like China do not have consumer protection and product liability laws like we have in the United States.
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<span style="font-family: "trebuchet ms", sans-serif; font-size: 12pt;">Posted by Tracy Green, Esq. </span><br />
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<a href="https://www.greenassoc.com/compliance" style="background-color: white; font-family: "trebuchet ms", sans-serif;" target="_blank">Green and Associates, Attorneys at Law</a></div>
Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-88820326622819248792019-05-31T10:27:00.000-07:002019-05-31T10:42:20.703-07:00Lengthy Sentence Imposed Upon Patient Recruiter for Home Health Services Where Illegal Kickbacks Were Paid to Doctors and Patients<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLREP38MsTsWxOszdCs1DmHBb5S8mEZ59FU6pfmWD61g2wyONMsGsdusTTiXjK0s70UqSfFhwhRpXELpUFfgfnuTarmVdopo9-M6V3WAAmMOJgcoOPfKQqZuoLHBQaPSEnsM5ksHf4bSVm/s1600/354767525_c7eeada85f_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="187" data-original-width="240" height="155" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLREP38MsTsWxOszdCs1DmHBb5S8mEZ59FU6pfmWD61g2wyONMsGsdusTTiXjK0s70UqSfFhwhRpXELpUFfgfnuTarmVdopo9-M6V3WAAmMOJgcoOPfKQqZuoLHBQaPSEnsM5ksHf4bSVm/s200/354767525_c7eeada85f_m.jpg" width="200" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">A
Houston, Texas patient recruiter and home health agency owner was sentenced to 188 months in prison today
for her role in a $20 million scheme to pay illegal health care kickbacks to
physicians and Medicare beneficiaries in order to fraudulently bill for
medically unnecessary home health services, and to launder the proceeds. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Health care fraud sentences continue to get longer. One recent case involved a lengthy sentence even though it was part of a guilty plea. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">On May 29, 2019, a Houston, Texas patient recruiter</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;"> Egondu "Kate" Koko was sentenced to 188 months (over 15 years) in federal prison for her role in a federal </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 16px;">health care fraud </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">case where she admitted she paid illegal kickbacks to physicians and Medicare beneficiaries in order
to fraudulently bill for medically unnecessary home health services for four other home health agencies and her own. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">The sentence came after Ms. Koko pleaded guilty in October 2018 to one count of conspiracy to pay and receive health care kickbacks and one count of conspiracy to launder monetary instruments. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">This sentence was lengthier than the norm since there was a money laundering count as in her plea she admitted she laundered the proceeds through another person's bank account. </span><br />
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<a name='more'></a><span style="font-size: 12pt;"><span style="font-family: "trebuchet ms" , sans-serif;">The judge also ordered Ms. Koko to </span></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">pay $12.9 million in
restitution and to forfeit $1,378,552.00. Restitution is very high in health care kickback cases since if an illegal referral fee is paid even for medically necessary services, the entire amount billed is considered a false claim and the entire amount collected is subject to restitution. This means the loss amount is high. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">As part of her guilty plea, Ms. Koko admitted to being
a patient recruiter for Criseven Health Management, Beechwood Home Health, JMM
Home Health and Trinity Healthcare Service, home health agencies that operated
in the Houston area. Ms. Koko was also the owner and operator of Circuit Wide
Home Health Services, a home health company. This type of fact would be used to show that as a Medicare provider she would know the rules barring payment for referrals. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Ms. Koko admitted that she paid
illegal kickbacks and bribes to physicians and patients for paperwork necessary
for Criseven, Beechwood, JMM, Trinity and Circuit Wide to bill Medicare. Ms. Koko and the other agencies submitted and were
paid more than $9.5 million but less than $25 million in claims to Medicare for
home health services purportedly provided by them. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Ms. Koko also admitted to committing money
laundering by opening a bank account under the identity of another person who was a Nigerian
national. Ms. Koko transferred proceeds from the health care fraud from accounts she controlled into the bank account of the Nigerian
national. Ms. Koko also admitted that she purchased a home using the funds
from the Nigerian national’s account which were proceeds from the fraud. </span><br />
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<b style="font-family: "trebuchet ms", sans-serif; font-size: 12pt;">Attorney Commentary: </b><span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">By this time, one would think that home health, hospice and health care businesses would know well the peril and severe risks of using patient recruiters and paying patients or physicians. Any marketing done by health care businesses need to be vetted to ensure compliance with state and federal health care laws.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 12pt;">Often in cases like this, there is a pattern where patients are with one agency for a certified period and then the patient is transferred to another agency. With big data available to Medicare and the government, the patterns of the patients being rotated to different agencies can become obvious in a short time period.</span></div>
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<span style="font-family: "trebuchet ms" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="https://www.greenassoc.com/white-collar" target="_blank">Posted by Tracy Green, Esq.</a></span></div>
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Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.comtag:blogger.com,1999:blog-3975712720282233811.post-73899774602268597742019-05-23T15:59:00.000-07:002019-05-23T15:59:03.509-07:00Podiatrist Sentenced in Upcoding Medicare Fraud Case for Patients Seen at Assisted Living Facilities<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBWwFx8YPsex3xIFul4XxZb-36w8QEjsfDSpIOVv149MBy_VL7NqX0xQblFjlUh90T_I6mFz2P0VI5ySpzRdmXS9OafPkRuk-cN0wRDeAuM_g1Fh3DIvH_ZVI4PsmXF3xAEhvAniFk9UFN/s1600/2592295709_9fdaac6b21_m.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="240" data-original-width="174" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBWwFx8YPsex3xIFul4XxZb-36w8QEjsfDSpIOVv149MBy_VL7NqX0xQblFjlUh90T_I6mFz2P0VI5ySpzRdmXS9OafPkRuk-cN0wRDeAuM_g1Fh3DIvH_ZVI4PsmXF3xAEhvAniFk9UFN/s200/2592295709_9fdaac6b21_m.jpg" width="145" /></a></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">Years ago, health care fraud cases would generally only be brought for outright fraud where there was ghost billing for patients not seen or other type of fraud. However, upcoded billing is now being charged more often when there is a significant pattern. A recent case involving a podiatrist illustrates this.</span></div>
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<span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">On May 17, 2019, podiatrist Loren Wessel of Tucson, Arizona was
sentenced by U.S. District Judge James Soto for his role in a
Medicare fraud scheme </span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">to serving a 24-month term of imprisonment</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 12pt;">. Mr. Wessel had previously pleaded guilty to Health Care
Fraud. T</span><span style="font-family: "Trebuchet MS", sans-serif; font-size: 16px;">he Court also ordered Wessel to pay $965,985 in restitution to the Centers for Medicare and Medicaid Services.</span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">In the plea agreement, Mr. Wessel admitted that from 2008 through June 2016 that he as a licensed podiatrist defrauded Medicare out of hundreds of thousands of dollars. In his plea
agreement, Mr. Wessel admitted he submitted false claims to Medicare. As part of
his practice, Mr. Wessel conceded that he regularly provided routine podiatry care for patients at
assisted living facilities in and around Tucson, but fraudulently billed
Medicare for more complex and significantly more expensive services that he had
not performed. To further this upcoding, Mr. Wessel admitted that he falsely
documented patients’ medical records with alleged ailments they did not have
and with care Mr. Wessel did not provide.</span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;">Posted by Tracy Green, Esq.<o:p></o:p></span></div>
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<span style="font-family: "Trebuchet MS","sans-serif"; font-size: 12.0pt;"><a href="https://www.greenassoc.com/white-collar/health-care-fraud.html" target="_blank">Green and Associates, Attorneys at Law</a></span></div>
Green and Associateshttp://www.blogger.com/profile/15080534127378202708noreply@blogger.com