Drug Medi-Cal Fraud Case Set for Trial in May 2016 For Alleged Submission of False Claims for Alcohol and Drug Treatment and Counseling for Students

Trial is set for May 10, 2016 in federal court in Los Angeles regarding the operation of a Caliornia Drug Medi-Cal provider Atlantic Health Services, formerly known as Atlantic Recovery Services (ARS) in which eight individuals were indicted and charged with health care fraud and aggravated identity theft.

The Drug Medi-Cal programs in the schools was a unique program and there may be very good defenses to this case given the County contracts, the approval of billing and submissions in the past, the State agency that regulated these programs and upon which the programs relied, and the aggressive tactics that Medi-Cal used when it decided to cut these programs.  

The overall allegation was that ARS submitted more than $50 million in fraudulent bills to a California state program for alcohol and drug treatment services for high school and middle school students that, in many instances, were not provided or were provided to students who did not have substance abuse problems. 

The eight defendants are all former employees of ARS, which received contracts to provide substance abuse treatment services through the Drug Medi-Cal program to students in schools in Los Angeles County. 

The schools included various sites operated by Soledad Enrichment Action and public schools in Montebello, California, Bell Gardens, Californina, Lakewood, and the Antelope Valley. ARS submitted claims for payment to the Drug Medi-Cal program for at least ten years and ARS shut down in April 2013, when California suspended payments to the company.

OIG Exclusion and Reinstatement of Excluded Individuals and Entities

One of the collateral consequences of criminal convictions for health care professionals is exclusion by the Office of Inspector General (OIG). The OIG exclusion list should be reviewed to confirm that the individual or entity is on it.

We have also seen individuals who were excluded and did not know it due to issues such as being in default of student loans.

One issue to understand is that reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid (Medi-Cal) and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.

We have handed numerous reinstatement requests. OIG runs a background and one of the key issues is whether the individual or entity has been following the exclusion rules. We advise people to calendar 90 days before reinstatement period ends since the process can be started at that time. 

Pennsylvania Physician And One Other Plead Guilty To Health Care Fraud Charges Arising From Writing A Fraudulent Prescription in Another Person's Name

Writing a prescription in another person's name is a fraudulent prescription. When that visit or prescription in the other person's name is billed to Medicare or insurance, then there is also health care fraud. When a Schedule II drug is involved, there is also a potential drug count.

On January 15, 2016,  Dr. John Terry and Stephen Heffner, Jr. pleaded guilty before Chief United States District Court Judge Christopher C. Conner in Williamsport, Pennsylvania.

According to the plea agreement, in April 2013, Dr. Terry caused Medicare to be billed for fraudulent prescriptions intended for Mr. Heffner knowing that Mr. Heffner was not his patient and that the Oxycodone was not actually intended for Mr. Heffner but for Dr. Terry’s patient, David Hatch of New York.  Medicare paid for the prescription received by Mr. Heffner but actually delivered to Mr. Hatch.

Riverside Woman Convicted in Federal Court of Stealing Identities of Residents of Medical Facility in Long Beach. Reason Facilities Need Strong HIPAA and Privacy Procedures.

One of the reasons medical facilities should have strong HIPAA policies and procedures, as well as enforcement and training, is to prevent employees or third parties from taking medical information for other improper or illegal purposes.

Last week, Bridgette Jackson of Riverside, California was convicted in federal court after a jury trial on federal identity theft charges for possessing the identities of more than 50 patients of a residential medical facility in Long Beach formerly known as the Hillcrest Care Center. She was convicted of conspiring to possess more than 15 identities, possessing more than 15 identities, and aggravated identity theft.

Ms. Jackson’s aunt, who testified against her at the trial, was an employee at the Hillcrest Care Center and had access to all of the patient files. According to the testimony at trial, Ms. Jackson approached her aunt and asked for personal identifying information of patients. Ms. Jackson’s aunt copied or wrote down personal identifying information and provided it to Ms. Jackson on three separate occasions. 

Ms. Jackson then used that information to help others file false tax returns in the names of the patients and keep the refunds for themselves. When law enforcement executed a search warrant on Ms. Jackson’s residence, officers seized approximately 56 Hillcrest medical records, along with almost 70 other identity profiles, which included names, social security numbers, and dates of birth of individuals other than Ms. Jackson. Law enforcement also seized over 50 prepaid debit cards in names of people other than Jackson.

After the jury verdict was reached, United States District Judge Manuel L. Real scheduled a sentencing hearing for March 7. At that time, Jackson will face a mandatory minimum sentence of two years in federal prison and a statutory maximum sentence of 17 years.   In an unrelated case, Ms. Jackson pled guilty last year to conspiring to commit credit card fraud in the United States District Court in Riverside and faces up to five years when she is sentenced in that case on March 28.

Attorney Commentary:  The black market for patient identity exists. Low paid clerical or medical workers can be susceptible to third parties (here a family member) seeking information. In addition, health care facilities' computer systems are now being targeted. Having a HIPAA audit and compliance is key so the facility does not face civil liability by the patients or OIG fines for the HIPAA violations.

Posted by Tracy Green, Esq.
Work: 213-233-2260

California Hospital to Pay More Than $3.2 Million to Settle Allegations That It Violated the Physician Self-Referral Law Following Self-Reporting in 2011

Hospitals walk a narrow path when they contract with doctors to run departments, fill on-call panels and serve on committees. A federal anti-kickback statute prohibits exchanging anything of value for the referral of Medicare or Medicaid (called Medi-Cal in California) patients. 

Another set of complicated rules, often called the Stark law, bans doctors from referring federally insured patients to facilities where they have financial relationships. Yet another law, the False Claims Act, subjects hospitals to treble damages if they bill the government fraudulently.

A recent case shows how a hospital decides to bite the bullet, self report when new administration takes over, and avoid risk of whistleblower action. While ultimately there will be payment of a high financial fine, the benefit of final resolution is important.  

On January 15, 2016, Tri-City Medical Center, a hospital located in Oceanside, California, agreed to pay $3,278,464 to resolve allegations that it violated the Stark Law and the False Claims Act by maintaining financial arrangements (on-call agreements mainly) with community-based physicians and physician groups that violated the Medicare program’s prohibition on financial relationships between hospitals and referring physicians. 

The contracting lapses that led to Tri-City’s settlement do not involve patient steering, financial conflicts of interest or false claims. However, rates found in five of the nearly 100 documents, when taken in the aggregate, may have been above fair market value, according to a 2012 self-disclosure report the hospital filed with the Office of Inspector General.

Tri-City voluntarily disclosed the contracts to the federal government in 2011 and had been negotiating a settlement ever since. At issue were 97 physician contracts that were missing, unsigned, expired or otherwise not compliant with federal health laws.

The fine, one of the largest ever against a hospital in San Diego County, comes at a critical moment for Tri-City. In October, the hospital became affiliated with UC San Diego Medical Center in an effort to expand specialties such as neurology, cardiology and gynecologic oncology. 

Durable Medical Equipment Company Pays $600,000 to Settle False Claims Act Allegations for Using Unlicensed Technicians for Respiratory Therapy

On January 12, 2015,  J and L Medical Services, LLC in Connecticut entered into a civil settlement agreement with the federal and state governments in which it will pay $600,000 to resolve allegations that it violated the federal and state False Claims Acts.         

J&L Medical is a durable medical equipment company.  As part of its business, it provides Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) devices and accessories to Medicare and Medicaid beneficiaries who have been diagnosed with obstructive sleep apnea.

It is alleged that J&L regularly utilized the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines.

Under Connecticut law, the practice of respiratory therapy is a licensed activity.  It is alleged that the respiratory therapy services in question could only be legally performed by licensed respiratory therapists. Unlicensed practice issues are arising more frequently in audits, qui tam cases and criminal prosecutions.

President of Miami-Based Transportation Company Convicted at Trial of Conspiracy to Pay Health Care Kickbacks By Using His Company to Pay Recruiters for Mental Health Clinics

Marketing is the dirty secret in a lot of health care businesses. Many businesses are not compliant with the anti-kickback statutes. Some marketing arrangements are not compliant and use sham arrangements to pay referral fees. In one case, it was alleged that a transportation company was used to pay referral fees to patient recruiters who referred patients to mental health clinics (not the transport company).

Health care kickback cases are going to trial more often due to the increased enforcement and number of cases being filed. In one case, after three co-defendants plead guilty, the last remaining codefendant went to trial and was convicted by a jury. 

One of the issues with the kickback laws is that payment of a unlawful referral fee make the entire claim false and criminal. This prosecution shows how one charged with kickback can be alleged to be responsible for any and all billing by the companies who paid referral fees for patients and then provided treatment (allegedly unnecessary) to those patients.

On January 8, 2016, Damian Mayol (president of a Miami-based transportation company Transportation Services Providers Inc.) was convicted after trial of one count of conspiracy to pay health care kickbacks. He was acquitted of two counts of payment of kickbacks. However, the conspiracy count has an enormous loss amount alleged ($28 million paid and $70 million of intended loss billed). Sentencing is set for March 11, 2016.

According to evidence presented at trial, Mr. Mayol and others used the transportation company to coordinate the payment of illegal health care kickbacks to recruiters, who in return referred patients to three now-defunct clinics in the Miami area:  R and S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. (St. Theresa) and New Day Community Mental Health Center LLC (New Day). The defense claimed that there was a contract with R and S and that the government did not meet its burden on proving that payments were for kickbacks. 

In October 2015, co-defendants Santiago Borges, Erik Alonso and Cristina Alonso pleaded guilty to related charges and were sentenced in December 2015 to prison terms ranging from 28 months to 120 months.

Physician Assistant Sentenced To 14 Months In Prison For Accepting Illegal Kickbacks for Referring Patients to Home Health, Physical Therapy and Medical Clinics

The U.S. Attorney's Office is willing to prosecute criminal cases even where small kickback amounts are at issue. A recent Michigan case shows that even $1,000 kickback payments will be prosecuted.

On January 12, 2016, physician assistant Kyle D. Gandy, who formerly resided in Michigan, was sentenced to 14 months in prison and two years of supervised release for accepting $1,000.00 in illegal kickbacks for referring patients to medical clinics, physical therapy clinics, and a home health care agency. 

As part of this felony conviction, Mr. Gandy was ordered to pay $18,030.17 in restitution, representing the amount of the referred services paid by Medicare and Medicaid. 

PA Gandy will also face collateral consequences from the conviction from his licensing board and he will be excluded from participating with the Medicare and Medicaid programs for at least five years.

Nation’s Largest Nursing Home Therapy Provider (Kindred/Rehabcare) Pays $125 Million to Settle Civil False Claims Act Allegations For Physical, Speech and Occupational Therapy Services Improperly Billed to Medicare

Skilled nursing facilities (SNFs) face many challenges in providing, documenting and billing therapies (speech, occupational and physical) to its patients. A recent large settlement in a false claims case brought by former employees, where the government intervened, against the nation's largest nursing home therapy provider shows other SNFs and therapy providers what they need to monitor in order to avoid similar allegations.

On January 12, 2016, contract therapy providers RehabCare Group Inc., RehabCare Group East Inc. and their parent, Kindred Healthcare Inc., agreed to pay $125 million to resolve a government lawsuit alleging that they violated the False Claims Act by knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred.

The government’s complaint alleged that RehabCare’s policies and practices, including setting unrealistic financial goals and scheduling therapy to achieve the highest reimbursement level regardless of the clinical needs of its patients, resulted in Rehabcare providing unreasonable and unnecessary services to Medicare patients and led its SNF customers to submit artificially and improperly inflated bills to Medicare that included those services.  Specifically, the government’s complaint alleged that RehabCare’s schemes included the following:

(1) Presumptively placing patients in the highest therapy reimbursement level, rather than relying on individualized evaluations to determine the level of care most suitable for each patient’s clinical needs;

(2) During the period prior to Oct. 1, 2011, boosting the amount of reported therapy during “assessment reference periods,” thereby causing and enabling SNFs to bill for the care of their Medicare patients at the highest therapy reimbursement level, while providing materially less therapy to those same patients outside the assessment reference periods, when the SNFs were not required to report to Medicare the amount of therapy RehabCare was providing to their patients (a practice known as “ramping”);

Dallas Compounding Pharmacy and Three Individuals Agree to Consent Decree With Permanent Injunction to Prevent Distributing Adulterated Drugs

Compounding pharmacies have been under scrutiny, and a recent case shows the difficulties compounding pharmacies are having complying with recent changes in the law and regulations. Compoung pharmacies are also under scrutiny due to billing issues with insurance which has also put them under the spotlight.  A recent case shows what happens when retail pharmacies engage in compounding with regulation by the state and what happens when the U.S. Food and Drug Administration (FDA) alleges the drugs are adulterated.

There are some hot issues on new compounding regulations and how they affect the Compounding Quality Act signed into law in 2013 and the FDA's increased audits and inspections of outsourcing facilities or pharmacies who may not be properly classified. Compounding pharmacies are having issues in determine whether they fall within the 503A and 503B rules and are complying with the federal regulations.

The U.S. District Court for the Northern District of Texas entered a consent decree on January 11, 2016, for permanent injunction against Downing Labs LLC, Ashley Michelle Downing, Christopher Van Downing and Roger E. Mansfield to prevent them from distributing adulterated drugs in interstate commerce.

Downing Labs was a state pharmacy regulated by the state. When Downing was named in a news investigation of having billed for compounding creams and gels not delivered to patients, they became a target of investigation. In addition, Downing decided to obtain FDA approval as an outsourcing facility and after inspection did not agree to recall drugs as demanded by the FDA.

Sacramento Dentist Pleads Guilty to Billing for Unnecessary or Unperformed Dental Work Billed to Delta Dental From 2008 to 2010

We have seen an increasing number of audits by Delta Dental where billing for services not provided is suspected. In some cases, the issue is that non-covered services (such as implants) are being performed and there is false documentation and billing for "covered" services. Or we have seen that one patient has dental coverage and work is performed on another family member who does not have coverge.

What triggers audits? It can be discrepancies in records, significant increases in billing, or complaints by former employees or patients. Or it can be a routine audit. In a recent case, a former employee went to the Dental Board to set forth allegations against her former dental office. That disclosure triggered action by the Dental Board (interim suspension), an Accusation and then a federal criminal case. It took five years for this to play out. In the meantime, the dentist surrendered his license in August 2013.

This recent case demonstrates what can happen in these cases. Dentist David M. Lewis of Sacramento pleaded guilty on January 11, 2016 to health care fraud for his role in defrauding the health care benefit program used by United Parcel Service (UPS) employees. Undoubtedly, this has been a long hard road for the now former dentist.

A former employee at Lewis’s dental practice for 9 years, Nichol Ramirez aka Nichol Lomack, who worked as an insurance claims manager, cooperated with the Dental Board and government. She ultimately pleaded guilty to one count of health care fraud for her part. She was interviewed by the Dental Board in December 2010 and the case went from there.

In October 2011 the Dental Board executed a search warrant at the dentist's office. The search warrant was used so that the dentist would not have advance notice and have any ability to alter or destroy the charts. After the charts and xrays were submitted for expert review, the Dental Board filed an Interim Suspension Order in February 2012 and filed an Accusation. In August 2013, Dr. Lewis surrendered his license. In February 2014, Lewis was indicted on health care fraud and conspiracy to commit health care fraud and mail fraud.

According to court documents, beginning in late 2008 or early 2009 (after the economic recession), Dr. Lewis, a dentist practicing in Sacramento, began targeting UPS employees for dental treatment because their health care plan under the Northern California General Teamsters Security Fund provided 100 percent coverage without any annual limits. Dr. Lewis' office allegedly offered cash and other incentives (Sonicare toothbrushes for example) to UPS patients for receiving dental treatment or for recruiting other UPS employees to receive such treatment.

In some instances, Dr. Lewis' office submitted claims to Delta Health Systems, which administered the UPS health care plan, that billed the plan for work that was never performed. In other instances, it was alleged that Dr. Lewis performed unnecessary dental work on UPS employees, including root canals, and claims were submitted to Delta for payment for these unnecessary services.

Doctor Who Pre-Signed Prescriptions for Psychiatric Drugs Allegedly Diverted to Black Market and Billed to Medicare Sentenced to Nine Years in Federal Prison

A Los Angeles physician was sentenced to a long sentence after trial in an unusual case involving the prescribing of anti-psychotic medications to recruited paid patients who did not need them. The patients then returned the medications to other codefendants (not the doctor or pharmacy) for resale on the black market to other pharmacies. This investigation was called "Operation Psych Out." 

It was alleged that the prescriptions were all written Dr. Johnson's name from 2009 to 2011 and that he never examined or evaluated these patients for the prescriptions. Prescriptions were pre-signed and issued by another codefendant Nuritsa Grigoryan (a doctor in Armenia but not licensed here) to the patients. These prescriptions were then filled at pharmacies and then the patients allegedly gave the medications back to other codefendants, who then sold and redistributed the medications on the black market. 

The charges related to the time period September 2009 to October 2011 where non-physician managers Lianna “Lili” Ovsepian and her brother Artak Ovsepian (who were co-defendants) operated a medical clinic known as Manor Medical Imaging in Glendale, California. Dr. Johnson was not an owner.  

On January 6, 2016, Dr. Kenneth Johnson received a lengthy 108-month (9 year) prison term from United States District Judge S. James Otero who said he wanted the sentence to “deter others from engaging in this type of conduct, especially physicians.” Dr. Johnson was convicted after being found guilty after trial in 2014. Although Dr. Johnson's role was much more limited than some of his codefendants, the fact that he pre-signed the prescriptions was viewed as a critical role by the government. 

Former UCSD Professor's Tech Company That Applied for Government Grants and Contracts Admits and Pleads Guilty to Wire Fraud, Agrees to Forfeit $180,000. False Statements in Government Applications Carry Exposure. Owner Gets "Deferred Prosecution Agreement."

False statements in any documents submitted to the government for payment can result in fraud charges. During the 1990s, government qui tam and criminal contracting fraud cases were common. We are seeing an increased number of companies being investigated for government contract fraud. These are usually handled by the Office of Inspector General (OIG) 

In an unusual case involving government grants and contracts, Dr. Homayoun Karimabadi, a former research professor at the University of California, San Diego (“UCSD”) and the Chief Executive Officer for SciberQuest, Inc., was charged in federal court last week with fraudulently obtaining government grants and contracts.

Dr. Karimabadi and SciberQuest, Inc., the corporation run by Dr. Karimabadi, both waived indictment and were arraigned on an information charging them with felony wire fraud and criminal forfeiture.  SciberQuest entered a guilty plea before U.S. Magistrate Judge Karen S. Crawford. Additionally, Dr. Karimabadi and SciberQuest jointly agreed to forfeit $180,000 as money that was improperly received as a result of the alleged fraud, in addition to a fine that will be imposed on the corporation at sentencing. 

In a favorable resolution for Dr. Karimabadi, he is scheduled to enter into a "deferred prosecution agreement" on January 15, 2016 at 8:30 a.m. before Judge Gonzalo P. Curiel. A deferred prosecution agreement is an agreement between a criminal defendant and the United States Attorney’s Office where the defendant admits to the facts constituting a criminal offense, but the United States agrees to suspend the entry of judgment for a period of time and agrees to dismiss the charges if, during that period, the defendant complies with certain conditions set forth in the agreement.These are not easy to obtain and show that either there were weaknesses in the government's case against Dr. Karimabadi or that fairness supported this result.  

Los Angeles Nightclub Owner and Sacramento Construction Company Owner Arrested for Workers' Compensation Insurance Fraud, EDD Payroll Tax Fraud. Get Compliant and Seek Professional Advice When Faced With Audits.

On January 8, 2016, two criminal cases were filed against individual company owners for workers' compensation insurance fraud and payroll tax evasion in Los Angeles and Sacramento. 

These are not related cases but show the the Department of Insurance’s effort to pursue more workers’ compensation premium fraud and tax evasion cases for misclassifying employees as independent contractors or paying employees cash under the table. The State views this as its efforts to combat the underground economy.

In the Sacramento case, William Huffman (owner of Capitol City Contractors) was charged with  nine felony counts of workers' compensation insurance fraud and tax evasion. The Sacramento County District Attorney's Office is prosecuting this case and contends that losses total $187,707. The State contends that Mr. Huffman allegedly underreported $755,899 in payroll to avoid paying workers' compensation premiums for dozens of employees.

How did this case arise? An insurer notified the Department of Insurance of suspected fraud. A forensic audit of the company's bank records was conducted and it is contended that detectives discovered evidence that Mr. Huffman was paying employees under the table and classifying some payroll checks as expenses for supplies and materials.

Attorney Commentary: We have helped numerous companies during the audit stages of workers’ compensation or EDD audits given the potential for criminal charges. During these audits, there are things that can be done to prevent the cases from being perceived as criminal intent to defraud cases. Compliance and immediate business changes can also help avoiding criminal charges. False documentation, false statements and other facts can cause problems. Companies often handle these audits on their own without detached counsel to advise them on how to proceed when there are sensitive issues and potential past non-compliance.

Non-Physician Owner of Three Los Angeles Medical Clinics Sentenced to 78 Months in Federal Prison for Medicare Fraud. Long Sentences Are The New Norm for Health Care Fraud.

The former owner and operator of three medical clinics located in Los Angeles, Hovik Simitian, 48, was sentenced on January 4, 2016 to 78 months in prison for his role in alleged submission of more than $4.5 million in fraudulent claims to Medicare. He is not a physician and under California law it is not legal for him to own or control the medical clinics. This was a high sentence given that it was a plea but is indicative of the government's position in demanding long sentences in these federal cases.  

The sentence was after Mr. Simitian pleaded guilty to one count of conspiracy to commit health care fraud on Aug. 18, 2015, and was sentenced by U.S. District Court Judge Beverly Reid O’Connell of the Central District of California, who also ordered Simitian to pay over $1.6 million in restitution to Medicare.

Mr. Simitian allegedly owned and operated Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic, three medical clinics in Los Angeles.  In connection with his guilty plea, Mr. Simitian admitted that from approximately February 2010 through June 2014, he and his co-defendant Anahit Shatvoryan paid illegal cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics.  

Dallas-Based Home Health Company Owners and Nurses Charged for Roles in Alleged Medicare Fraud for Home Health Over 8 Year Period

On December 22, 2015, the co-owners of a home health company in Dallas and two nurse employees were charged in an indictment for their alleged participation in a health care fraud case involving alleged fraudulent claims for home health services. 

The government alleges that the billing at issue was $13.4 million to Medicare and Medicaid. It is also alleged that there were some payments to recruiters and that some of the services were performed were medically unnecessary. 

Patience Okoroji and Usani Ewah are alleged to co-own Timely Home Health Services Inc. (Timely). Kingsley Nwanguma LVN and Joy Ogwuegbu RN are alleged to have worked for Timely. Each of these four individuals of Texas were each charged with one count of conspiracy to commit health care fraud and each were charged with three or more counts of health care fraud. An Indictment is not evidence and all persons charged are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law. 

The indictment alleges that from approximately January 2007 to September 2015, the defendants conspired to defraud Medicare by causing the submission and concealment of false and fraudulent claims for home health services in the amount of $13,434,550.  

According to the allegations, Okoroji and Ewah would in some cases pay recruiters, including Nwanguma, to recruit beneficiaries for home health services, regardless of whether the beneficiaries needed home health care.  The government contends that Okoroji, Ewah and Ogwuegbu allegedly prepared or caused to be prepared fraudulent Medicare documents that made it appear that the beneficiaries qualified for home health services.  These documents were used by doctors to certify Medicare beneficiaries for home health care.  

Attorney Commentary - Ethnic Community Issue: This is the latest case involving immigrants (naturalized citizens) involved in home health care fraud with hundreds of investigations in Dallas alone since 2012. Other cities such as Los Angeles, New York, Miami, and Detroit involve a high percentage of ethnic communities.

Santa Barbara Doctor Sentenced After Trial to over 25 Years in Federal Prison for Writing Prescriptions for Schedule II Narcotics

The war on prescription drug abuse and the physicians who were prescribing to pain management patients continues. Long sentences are being handed out and the most recent case is no exception. 

On December 7, 2015, a Santa Barbara-area physician Julio Gabriel Diaz who wrote numerous prescriptions for Schedule II drugs was sentenced to a very long sentence of 327 months (essentially a life sentence) in federal prison by United States District Judge Cormac J. Carney. The sentence will be appealed according to his appointed attorney.

Former physician Diaz was found guilty by a jury after a 2½-week trial in August of 79 counts of distribution of a controlled substance. The government produced evidence at trial that the prescriptions were outside of the usual course of professional practice and without a legitimate medical purpose. Dr. Diaz was not charged with any patient deaths but evidenced was introduced that many patients were drug addicts and some died from drug overdoses.

Dr. Diaz was profiled, along with other physicians, in a Los Angeles Times profile on physicians overprescribing narcotics. The prosecutions of these physicians became politicized. Dr. Diaz was arrested in 2012 with the Medical Board action against his license after his arrest. 

Four Home Healthcare Workers in Missouri Charged with Defrauding Medicaid - In Home Supportive Services Fraud

State programs pay home health care workers (IHSS in California) to take care of the non-medical needs of elderly and/or disabled patients who qualify for SSI. These services are performed at the patients' own homes since it is much less expensive than placing these patients in assisted living or nursing homes. 

This can be a great program. However, the concern about fraud threatens it. In addition, the individual providers are being targeted. These are not large companies but individuals who are often low paid workers. This article is to remind those providers to be careful and not to submit documents with false billing or entries on them regardless of the temptation. In California, it is considered Medi-Cal fraud.

Let's be clear. States are aggressively going after fraudulent billing in the home setting. California usually brings charges in state court but we can expect federal charges as well. Missouri just charged four individuals in federal court for billing for services not provided in November 2015, and they are expected to be sentenced in early 2016 following guilty pleas.