According to the plea documents, Ms. Crisologo was the owner and operator of J and F Community Medical Center Inc. Ms. Crisologo admitted that she submitted approximately $23 million in false and fraudulent claims to Medicare for HIV injection and infusion services purportedly provided through J and F. According to court documents, Ms. Crisologo hired a physician at J and F and conspired with the physician and others to order unnecessary tests, sign false medical analyses and diagnosis forms, and authorize treatments to make it appear that medical services were being provided to patients who were Medicare beneficiaries. The services included medically unnecessary injection and infusion therapies.
On the marketing and kickback side, Ms. Crisologo admitted that she and her conspirators paid Medicare beneficiaries kickbacks to induce the beneficiaries to claim they received legitimate services at the clinic when in fact the HIV infusion services were either not provided or were not medically necessary. The kickbacks make defense difficult in these cases since violation of the anti-kickback statute automatically makes a claim for a service that is provided a "false claim." The kickbacks also play into the medical necessity where the marketer encourages the beneficiary to falsely report symptoms in order to obtain services.
The maximum sentence for conspiracy to commit health care fraud is 10 years in prison. This is a high loss amount and unless there is significant cooperation, it is expected that the sentence could be lengthy. Ms. Crisologo also faces fines and forfeiture of any property or proceeds derived from the clinic. Sentencing is scheduled for November 23, 2010.
Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.
Any questions or comments should be directed to Tracy Green, a very experienced California health care fraud attorney and California Medicare fraud attorney at tgreen@greenassoc.com.
The firm focuses its 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 and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/
