Michigan Home Health Agency Assistant Director of Nursing Sentenced to Three Years for Role in Paying Kickbacks With $1.6 Million in Billings to Medicare

The assistant director of nursing of a Michigan home health agency, Juan Yrorita, age 63, was sentenced to 36 months in prison on March 29, 2018 by U.S. District Judge Drain for his role in a case involving approximately $1.6 million in Medicare claims for home health services that were procured through the payment of kickbacks, and that were also allegedly medically unnecessary and not provided.

Mr. Yrorita plead guilty after four days of trial to one count of conspiracy to commit health care fraud and wire fraud. As part of his guilty plea, Mr. Yrorita admitted that his co-conspirators at Anointed Care Services (Anointed), a Detroit-area home health agency, paid kickbacks to recruit Medicare beneficiaries.  Mr. Yrorita further admitted that as Anointed’s assistant director of nursing, he falsified medical records to support Anointed’s fraudulent claims to Medicare for services that were medically unnecessary and never provided. According to the evidence at trial, Anointed submitted approximately $1.6 million in false and fraudulent claims to Medicare. 

United States Resolves Civil Claims That Philadelphia Cardiologist Billed Medicare For Unnecessary Stent Procedures After Voluntary Self-Disclosure

Vidya Banka, M.D., a cardiologist and former director of Pennsylvania Hospital’s cardiac catheterization lab, has entered into a civil settlement agreement with the United States to resolve allegations that he improperly submitted Medicare claims for unnecessary cardiac stent procedures.  Here is the U.S. Attorney's Office press release about this case.

The University of Pennsylvania Health System (“UPHS”), which owns Pennsylvania Hospital, brought the matter to the United States’ attention through a voluntary self-disclosure relating to conduct from 2010 to 2012. In January 2017, UPHS reached a separate settlement with the United States. The United States then continued to investigate Dr. Banka and it resulted in this settlement where he pays $126,617 and agrees to a 5 year OIG exclusion.  This is usually a civil qui tam settlement with the government and is not a criminal matter.

Voluntary self-disclosures by hospitals are obviously not a free pass for the individual providers or group providers involved and the hospital's self-disclosure did not protect the provider from exclusion.  The exclusion for a cardiologist is a tough consequence given that it will make it impossible for him to perform any procedures at any hospital that accepts Medicare or government funding for 5 years. 

Posted by Tracy Green
Green and Associates

Los Angeles Dentist Charged in Federal Health Care Fraud Case

On March 12, 2018, a Los Angeles dentist was charged in federal court with six counts of health care fraud and two counts of aggravated identity theft. The identity theft counts are usually added in these cases since they add additional and potentially mandatory prison time which increases the pressure on those charged to plea. An Indictment is not evidence and the dentist is presumed innocent. Here is the link to the U.S. Attorney's Office Press Release.

San Diego Doctor and Seven Others Arrested for Allegedly Prescribing Opioids to Homeless, Dead and Incarcerated People With Medications Then Sold On the Street

The United State's Attorney's Office in San Diego has recently charged a physician and seven others in a case involving a clinic where pain medication prescriptions were then diverted.  Here is the press release from the U.S. Attorney's Office on the case. An Indictment is not evidence and the doctor and others are presumed innocent.

Former Dept of Justice Attorney Sentenced To 30 Months For Obtaining Information About Companies Named in Qui Tam Lawsuits and Using That Information in Private Practice.

Sometimes clients will believe that by hiring attorneys who have just left the government, they can obtain confidential information. While those attorneys have relationships with the other attorneys and agents, they have strict ethical rules where they cannot use information from a case they worked on in private practice. 

In an unusual and sad case, former Department of Justice attorney Jeffrey Wertkin was sentenced on March 7. 2018 to 30 months in prison for obstruction of justice and transportation of stolen property following a guilty plea last November relating to his "theft" of confidential information and documents on cases he personally was not working on and using it to obtain private clients.    

According to his plea agreement, Mr. Wertkin of Washington, D.C., worked for the Civil Fraud Section of the Department of Justice from October 24, 2010, until April 12, 2016. During that time, he worked on qui tam actions pursuant to which the government investigated companies suspected of breaking the law.  

Federal courts often order qui tam complaints “sealed” and therefore kept from public view until it is appropriate for the complaints to become public.  In his plea agreement, Mr. Wertkin admitted that during the last month of his employment as a trial attorney with the Department of Justice, he began secretly reviewing and collecting sealed qui tam complaints that were not assigned to him.  

Florida Physician and Ex-Wife Indicted in Health Care Fraud Conspiracy For Alleged False Claims to Medicare and Blue Cross Blue Shield for Allegedly Using False Diagnoses of Rosacea, Acne, and Actinic Keratosis to Perform Chemical Peels, Dermabrasions, and Acne Surgery

The world of private insurance billing has changed in that federal and state authorities will be brought in for claims of insurance fraud. In the old days, if a claim was denied it was denied. If it was approved, that was the end of it. 

There are dermatology and plastic surgery physicians who understand what procedures are covered (rhinoplasty due to deviated septum/sleep issues, laser treatments for serious rosacea or acne scars, etc.)where those procedures will also improve appearance.  There are other patients and physicians who push the envelope to create a diagnosis in order to get insurance reimbursement.  

The issue is where is the line? How far should doctors go to help patients get insurance coverage for cosmetic treatments? In today's world, a recent case can show the legal issues present when patients' insurance is billed for for cosmetic procedures.

After Jury Trial, Former Congressional Staffer Found Guilty on Federal Bribery and Extortion Charges for Taking $5,000 from Compton Marijuana Dispensary

Small businesses need to watch out for people who ask for donations or funds to make their compliance issues go away. A recent case ended up in criminal charges and a three-day trial that ended last week in a conviction.

On March 2, 2018, Michael Kimbrew, a former staffer for Janice Hahn, a Member of the United States Congress, was found guilty by a jury of bribery and attempted extortion after demanding and accepting $5,000 to prevent the closure of a now-defunct marijuana dispensary (Green Legends) on Long Beach Boulevard in the City of Compton in March through May 2015.

California Physician Sentenced in Sacramento Federal Court to over 4 Years in Prison for Prescribing Methadone and Pain Medications Without Proper Documented Medical Exams

One of the issues with physicians and former physicians is that the government can file charges years after the treatment. This is happening with those who prescribed pain medications years ago to patients. A recent case relates to patients from 2008 to 2012.

On February 22, 2018, a formerly licensed physician, Nicholas J. Capos Jr., 67, of Yuba City, was sentenced by U.S. District Judge Morrison C. England Jr. to four years and four months in prison for selling prescriptions of controlled substances such as oxycodone and methadone. This sentence followed a guilty plea.

According to court documents, between April 3, 2008, and October 30, 2012, Dr. Capos, who was then a licensed physician with a specialty in cardiology, allegedly knowingly and intentionally prescribed controlled substances without properly examining the patients and ignoring obvious signs that the patients were abusing or reselling the medications. He was charged with prescribed quantities far in excess of human tolerance and charged patients a “DEA Fee” of $100 per prescription, which is contrary to accepted medical practice. He is no longer licensed to practice medicine.