Internal Medicine Physician Convicted in Los Angeles Federal Court After Six-Day Trial of Conspiracy to Pay or Receive Kickbacks for Medicare Referrals and Four Counts of Receiving Kickbacks.

Health care fraud and kickback cases can be difficult to defend due to the amount of documentation and when there are numerous cooperating witnesses. A recent case, seemed to have a number of weak, inconsistent witnesses who had already plead guilty and were caught in direct mistruths and changing stories. However, the jury nevertheless convicted the doctor defendant.

On August 23, 2018, after a six-day trial, a federal jury convicted Dr. Kanagasabai Kanakeswaran an internal medicine doctor with a practice located in Lancaster, California of one count of conspiracy to pay and/or receive kickbacks for Medicare referrals and four counts of receiving kickbacks for Medicare referrals.

The government contended that the evidence presented at trial showed that from 2008 to 2016, Dr. Kanakeswaran and others engaged in a conspiracy to refer Medicare patients to Star Home Health Resources (Star), a home health agency located in La Verne, in exchange for illegal kickback payments. The government alleged that Dr. Kanakeswaran received kickback payments in cash, as well as through checks payable to a company Kanakeswaran owned, Digital Perfection Corporation.The defense denied that there were any payments for referrals. 

The witnesses against the doctor who owned or operated Star or worked as marketers had all plead in a separate criminal case and were shown to have misrepresented numerous facts and were caught in a number of lies. The defense moved to dismiss the case based on prosecutorial misconduct and under Rule 29 but these motions were not successful. 

“ABUSE OF LOYALTY”: THE PLAYERS, A FREE PRESS INTERVU - LAWYER PLAYERS IN SPECIAL COUNSEL AND COHEN INVESTIGATIONS

"ABUSE OF LOYALTY": Free Press Intervu with White Collar Crime Expert Tr...

Tracy Green, White Collar Expert Interview, on Special Counsel Investigation, Michael Cohen, FEC Issues, Etc. With Free Press Journalist Heidi Cuda

Dateline: Los Angeles, August 23, 2018. Independent investigative reporter and Free Press activist Heidi Cuda interviewed me to break down the prosecution tactics of Special Counsel Robert Mueller and his team. 

This is a "low-tech" interview that we set up impromptu via Skype...so hopefully the lags and tech issues don't bother you too much and you can listen to it like a podcast.

Here's a link to the interview which is posted on YouTube and entitled: "ABUSE OF LOYALTY": Free Press Intervu with White Collar Crime Expert Tracy Green"

I did my best, in a "just the facts, m'am" approach without being partisan to explain how the prosecution thinks and why these cases are so challenging. Regardless of political issues, I'm a believer in due process and I hoped to shed light on why Mueller as Special Counsel has proceeded in this manner so far and what we can expect as citizens watching from the armchair.

By the way, to read Emmy award-winning investigative producer Heidi Cuda's Free Press writings on the Trump-Russia investigation and media accountability, go to: https://maewestside.tumblr.com  

In my view, Heidi's style is unique and reflects her prior life as a music reporter for the Los Angeles Times and her punk rock approach to journalism. This was not her asking me for 5 two-sentence sound bites like I've had in mainstream interviews. She purposefully doesn't give questions beforehand or "practice" and wants it "real." So you'll see us having a conversation (with the informality that happens in normal conversations) from my home office to her home office. It's also different because we are not limited to 3 minutes of air time and luckily, I do not have to shout over other people on a panel. 

Among the highlights from the 40-minute interview: "PAPER DOESN'T LIE": "Particularly in a high profile case, the prosecution can't risk making any mistakes. They need evidence and documents that no one can challenge in court. Whatever case they file, they want to make sure it's gonna be bulletproof." "TRUMP" TACTICS: "Trump doesn't use email. He doesn't even like to use the mail. He likes to have things personally delivered. And he likes to have other people handle the communications. He doesn't appear to be texting. He delegates so it insulates him. When you come to try to make a white collar case...it makes it difficult because he's not leaving a paper trail."

Manafort Is Not Only One Charged With Failing to File an FBAR. Los Angeles Man Pleads Guilty to Not Reporting over $1 Million Held in Israeli Offshore Accounts.

The Justice Department just publicized this plea relating to FBAR at the same time that Paul Manafort has a jury deciding whether or not he willfully failed to file an FBAR. This may satisfy some pundits who claim that no one is ever prosecuted for failing to file an FBAR. This recent case relates to a bank with U.S. branches that had already signed a deferred prosecution agreement. The bank had likely been cooperating to reveal U.S. customers with foreign accounts.

On August 20, 2018, Ben Zion Birman pleaded guilty in U.S. District Court in Los Angeles to willfully failing to file a Report of Foreign Bank and Financial Accounts (FBAR), which would have disclosed his foreign bank accounts.

According to court documents, Mr. Birman held offshore accounts in Israel at Bank Leumi Le-Israel B.M. ("Leumi") from 2006 to 2011. Mr. Birman indicated in his plea that he willfully failed to file with the Department of Treasury an FBAR for calendar year 2010, despite having over $1 million in Bank Leumi accounts. 

The factual basis of the plea agreement alleges that in an effort to further hide his money, Mr. Birman instructed Bank Leumi to hold bank mail from delivery to the United States, and obtained access to his offshore funds through the use of “back-to-back” loans, which were designed to enable borrowers to tap their concealed accounts. These lending arrangements permitted Mr. Birman to have funds issued by Leumi’s U.S. branch that were secretly secured by funds in his undeclared accounts in Israel.

Former CEO of Non-Profit Medical and Dental Clinic Who Is Also Licensed Nurse Practitioner Pleads Guilty to Health Care Fraud in Fresno

We are seeing an increased focus on nonprofit health care entities that are run by individuals. One recent case shows how nonprofits can face scrutiny that includes conflict of interest issues and concern over whether payments to executives or employees.

On August 13, 2018, Sandra Haar pleaded guilty to health care fraud and conspiracy to receive kickbacks in federal court in Fresno.

Ms. Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities. Ms. Haar was also a nurse practitioner. Horisons is now closed but once had eight clinics.

According to court documents, between January 1, 2014, and March 2017, Ms. Haar allegedly orchestrated the billing to Medicare and Medi-Cal for services she knew were not reimbursable, and she allegedly profited by over $3.7 million from her fraud. For example, Ms. Haar allegedly billed Medi Cal for health and dental services that were not rendered and for unnecessary health care services.

Owner of Drug Rehab Facility Who Paid For Some Patients' Initial Health Insurance Payments and Waived CoPays and Deductibles Charged With Insurance Fraud by Riverside County District Attorney

There are times when health care facilities may contribute to paying a patients' insurance. For example, a patient who is hospitalized for some time where it is documented properly and financial need exists and it is disclosed.

However, can a health care facility pay for the initial premium that allows the patient to get treatment? Not usually. There are also some situations where copay and deductibles can be waived, but there are times when doing so is not allowed. These are two of the issues in a recent criminal case against the owner of a drug rehabilitation facility.

On March 25, 2018, David Leo Johnson, the owner of Southern California Detox Treatment and Recovery (SCDTR) in Temecula, was charged with 30 counts of insurance fraud and an aggravated white collar crime enhancement by the Riverside County District Attorney. The case is set for a felony settlement conference on August 29, 2018. The bail was set at $270,000 which is usually indicative of the alleged loss.

According to court pleadings, from February 2015 to May 2016, Mr. Johnson is accused of billing more than 90 Health Net policies for treatment SCDTR provided to its clients. This was a joint investigation by the DA’s Bureau of Investigation and the Federal Bureau of Investigation.

One issue is the payment of health insurance. It is alleged that an examination of the Health Net policies billed by SCDTR showed some policy applications used the SCDTR address as the policyholder’s residence and that Mr. Johnson's credit card was used to make the initial premium payments on 62 percent of the policies. 

Interviews with clients allegedly showed that they did not submit the applications for their health insurance policies and were not aware of how the coverage was obtained. When interviewed, the clients also allegedly advised that Mr. Johnson did not charge them any of the required patient costs, including deductibles and copayments.

California Physician Charged in Self-Referral Case With Felony Insurance Fraud and Perjury for Allegedly Referring Workers Comp Patients to a Laboratory and Surgery Center In Which He Allegedly Had Ownership Interest

Referring patients to other business entities that a physician has an ownership interest in can be a violation of the law depending on the type of patient (Medicare, workers' compensation) and it is important to ensure that the rules are being followed. California workers' compensation rules can be as more complex as those governing Medicare patients.

A recent case shows what can happen if the government contends that self-referral rules under the California Labor Code are violated for workers' compensation patients. There may be very good defenses here where the surgery center was part of the same practice and there was an in-office laboratory that is CLIA certified. 

A Corona physician (anesthesiologist who specializes in pain management), Dr. Sanjoy Banerjee, is charged with felony workers’ compensation insurance fraud (two counts Ins. Code Section 550(a)(1)) and perjury (five counts Penal Code 118(a)) by the Riverside County District Attorney’s Office after investigators claimed he referred patients to a clinical laboratory and surgical center he allegedly owned or had some ownership interest. Dr. Banerjee is presumed innocent.

Dr. Banerjee works as a pain management doctor who saw workers’ compensation patients  (probably among other types of patients) at a medical clinic he owned called Pacific Pain Care. The prosecution contends that Dr. Banerjee signed under penalty of perjury five workers' compensation doctor’s reports stating that he had not referred workers’ compensation patients to companies he owned. I doubt that is what the doctor's reports stated but it was probably just a form statement that there was no violation of Labor Code Section 139.3.

Investigators alleged that Dr. Banerjee had referred some of his patients to a "different business" he owned, Rochester Imperial Surgical Center, also located in the Pacific Pain Care office suite.  The prosecution alleges that Dr. Banerjee billed for more than $180,000 worth of urine toxicology testing and epidural injections through the laboratory and surgical center. One of the key issues will be whether this was a "different" business if it was owned by the same physician in the same office suite and met the exceptions of the in-office ancillary exception. If it met the exception, there is NO criminal case.

California Meat Processing Company and Two Company Officials Plead Guilty to Selling Misbranded Beef, Pork and Poultry They Falsely Claimed Had Been Inspected

Regulatory cases can turn criminal and the resolution often takes years. A recent case began on the regulatory side in 2012 and became a criminal case which has taken six years to resolve. The case has also cost the company millions of dollars in product seizures, recall requirements, legal fees and fines. It shows the potential risk of non-compliance.

On August 1, 2018, a meat processor Golden Key Food, Inc. dba AA Meat Products Corp. was investigated in 2012 by the U.S. Department of Agriculture (USDA) for selling meat that was produced without federal inspection. The government alleged that AA Meat products had a plant in Maywood that was operating under a USDA grant of inspection where meat and poultry food products were properly federally inspected, but that they had a second facility in Commerce did not have USDA inspection grant. USDA alleged that AA Meat produced and sold meat (such as trip, duck feet, and other less expensive parts) from its Commerce plant that had not been inspected but was stamped as if it had been inspected.

In 2012, the USDA investigators came in and seized approximately 568,000 pounds of meat and poultry products. The USDA then issued a Class I recall led to the recovery of another nearly one-half million pounds of meat – all of which had to be destroyed.