Increased Use of Nonprofits in Fraud Cases: Utah CEO of a "Charity" That Distributed Medical Supplies Sentenced for Tax Evasion

 

In our practice we have seen an increase in the number of charities or nonprofits in the health care or government contracts field. Often the problem is that the parties to not know how to run the charity according the federal and state tax rules. In addition, they often do not realize that both the federal agencies and states are able to use significant powers over non-profits.

In two recent related cases two men were involved in a federal tax fraud case involing a health care business charity.  What happened here? The CEO of a medical supply charity business, Ashley James Robinson, entered into a secret arrangement with a purported donor, Gurcharan “Jazzy” Singh. Mr. Singh provided medical supplies to the charity, making it appear as if these supplies had been donated to the charity thereby getting his company a deduction. 

Mr. Robinson then arranged for the charity to sell the goods to a third-party, passing most of the sale proceeds back to Mr. Singh. As compensation, Mr. Singh then paid Mr. Robinson, not the charity, up to 10% of the total proceeds. Mr. Robinson did not declare the income from Mr. Singh as income. 

As is common in these cases, over years the money adds up. According to court documents, from 2016 through 2019 Mr. Robinson that did not report a total of approximately $1,163,818 in income. As a result, Mr. Robinson caused a tax loss to the IRS of approximately $427,145. That is the loss amount. That will also be the restitution amount to be repaid. The more that can be repaid prior to sentencing, the better it will be obtaining a favorable sentence. 

The government also likes to allege facts showing that the person charged used the money to live lavishly or high on the hog as might be said in the South. Here the government alleged that Mr. Robinson used the funds to pay off the mortgage on his principal residence and to buy multiple luxury vehicles, including a Maserati, a Mercedes Benz and an Audi for a co-worker.

Mr. Robinson and his counsel must have decided that the defense was not strong and he pleaded guilty today to willfully evading the proper assessment of income tax. At sentencing, he was sentenced to federal prison for 1 year and one day (an excellent sentence since it allows him to serve just half the time.) The sentence implies that Mr. Robinson plead early, had mitigating circumstances in his background, and did not have any prior felonies. In addition to his prison sentence, U.S. District Judge Jill N. Parish for the District of Utah ordered Robinson to pay approximately $485,982 in restitution to the United States.

Mr. Singh has already been sentenced in the Central District of California to the same sentence of one year and one day.  These are relatively short sentences and hopefully these men can put this behind them, learn the lessons needed, and get on with their lives and back to their family.  We have seen so many clients get through these issues, and they do make it through the other side. 

Owner of Los Angeles Compounding Pharmacy Sentenced to 30 Months in Federal Health Care Fraud Case

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.

Compounding cases 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. 

According to court documents, Fusion Rx Compounding Pharmacy 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. Fusion RX was owned by Navid Vahedi, a Los Angeles pharmacist. 

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. 

San Joaquin County Doctor Convicted of Prescribing Opioids Without Medical Necessity to Patients in Federal Court

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. 

On November 19, 2021, Dr. Edmund Kemprud, age 78, was 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. 

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. 

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. 

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 during the undercover patient visits. Dr. Kemprud charged $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.

Case Study: Federal Embezzlement Charges Against California Controller. Top 5 Things to Learn From This Indictment

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. 

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. 

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.

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.

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. 

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.

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. 

California Rehabilitation Therapy Company With 11 Skilled Nursing Facilities Settles Medicare False Claim Allegations for Alleged Unnecessary or Unreasonable Services

Qui Tam Case Involving SNFs

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. The qui tam case is captioned United States ex rel. Pennetti v. Interface Rehab, et al., No. CV-14-4133 (C.D. Cal.).

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. The claims resolved by the settlement are allegations only and there has been no determination of liability. 
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.  

Sacramento Man Pleads Guilty to Medicare Kickback Scheme Involving Hospices and Home Health Agencies

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. 

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.

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. 

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.