On Thursday, October 22, 2009, I wrote about three of seven DME health care fraud cases filed in the Central District of California within the last few weeks.
An indictment merely contains allegations that a defendant or defendants have committed a crime. Every defendant is presumed innocent unless and until proven guilty at trial.
Here is a brief summary of the remaining four cases:
4th DME Health Care Fraud Case: Anait Garanfilyan, 47, of Los Angeles, was arrested on October 15 after being indicted on multiple counts related to the alleged payment of illegal kickbacks for Medicare patient referrals to two medical clinics in Los Angeles between February 2005 and May 2006.
In Case No. 2:09-CR-00919, Ms. Garanfilyan is charged with one count of 42 U.S.C. 1320a-7b(b)(2)A) for payment of kickbacks for patient referrals and one count of 18 U.S.C. 2 (aiding and abetting). Ms. Garanfilyan is scheduled to be arraigned on Monday, October 26.
5th DME Health Care Fraud Case: Mariya (Mary) Bagdasaryan, 54, and Edgar Srapyan, 26, both of Glendale, Calif., were indicted in Case No. 2:09-CR-00957 on charges of conspiring to commit health care fraud from October 2007 to December 2008.
Specifically, they are charged with (1) one count of 18 U.S.C. Section 1349 of conspiracy to commit health care fraud; (2) one count of 42 U.S.C. Section 1320a-7b(b)(2)A) for payment of kickbacks for patient referrals; and (3) and one count of 18 U.S.C. 2 (aiding and abetting).
Ms. Bagdasaryan allegedly operated a fraudulent DME company called Goldberg Medical Supply and allegedly submitted approximately $779,028 in false claims to Medicare for medically unnecessary power wheelchairs and wheelchair accessories. Ms. Bagdasaryan also is charged with paying illegal kickbacks for the referral of Medicare patients to Goldberg Medical Supply.
Mr. Srapyan, though an alleged fraudulent DME company, True Care Medical Supply, is alleged to have submitted approximately $647,356 in false claims to Medicare for unnecessary power wheelchairs and wheelchair accessories.
6th DME Health Care Fraud Case: Adejare Ademefun, 55, of Inglewood, was indicted for allegedly conspiring with others to submit more than $850,000 in false claims to Medicare for medically unnecessary power wheelchairs in Case No. 2:09-CR-00979.
Mr. Ademefun is charged with (1) one count of 18 U.S.C. Section 1349 of conspiracy to commit health care fraud; (2) five counts of 18 U.S.C. Section 1347 (health care fraud); and (3) and one count of 18 U.S.C. 2(b) (causing an act to be done). Mr. Ademefun is scheduled to be arraigned on Monday, October 26.
This case may be related to another health care fraud case, Case No. 08-1159-JFW, U.S. v. Floruncho Tosin Adeshina, since a notice of related case was filed. This indicates that Mr. Ademefun may be a witness in this other case.
7th DME Health Care Fraud Case: Sylvester Ijewere, 49, of Arleta, Calif., was named in a criminal complaint charging him with one count of health care fraud. Mr. Ijewere is associated with a DME company called Maydads that allegedly was used to submit nearly $500,000 in false claims to Medicare. Mr. Ijeware was arrested on October 21.
Attorney Comments: Each of these cases are ones where kickbacks and/or pure fraud -- billing for services not provided or not medically necessary -- are alleged. The vast majority of DMEs do not conduct themselves in this manner. However, these cases should alert DMEs to the fraud that exists in the system and make their best efforts to ensure that any prescriptions are valid and issued by the physician on the order form.
Attorney Comments: Each of these cases are ones where kickbacks and/or pure fraud -- billing for services not provided or not medically necessary -- are alleged. The vast majority of DMEs do not conduct themselves in this manner. However, these cases should alert DMEs to the fraud that exists in the system and make their best efforts to ensure that any prescriptions are valid and issued by the physician on the order form.
For example, assume a DME hires a marketing company. The marketing company assures the DME owner that they have all these contacts with physicians and can bring legitimate business to them. The order forms begin to arrive. The DME needs to contact the referring physicians on the order forms, check them out and ensure that this was ordered. It would also be wise to visit the office of the referring physician.
There is a market out there for fraudulent prescriptions and beneficiaries who sell their provider numbers. If a legitimate provider is caught up in this scheme, it can cause administrative problems (pre-payment review or loss of a provider number) and potential criminal problems.
Further, if the marketer has paid a kickback to a patient or physician, that order form will be a "false claim." That false claim will affect your DME's reimbursement. It is a chain reaction.
Marketing is fraught with issues and it is important for DME providers to be cautious and paranoid. An experienced health care attorney can advise as to the legality of the marketing arrangement and the type of due diligence that should be done to avoid future problems.
Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers including, but limited to, DME providers. Their website is: http://www.greenassoc.com/
