9/17/2018. Source: individuals-charged-in-2018-healthcarefraud-takedown

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1 OIG and DoJ reported charging over 600 individuals involved in fraud schemes that cost Medicaid and Medicare $2 billion. Of the over 600 defendants charged, 165 were medical professionals, including 32 doctors who allegedly participated in healthcare fraud schemes involving prescribing and distributing opioids and other narcotics. The charges jointly announced by the OIG and DoJ also involved claims submitted to Medicare, Medicaid, TRICARE, and private insurance companies for medically unnecessary prescription drugs that were oftentimes never purchased or given to patients. The charges jointly announced by the OIG and DoJ also involved claims submitted to Medicare, Medicaid, TRICARE, and private insurance companies for medically unnecessary prescription drugs that were oftentimes never purchased or given to patients. A Coeburn, Virginia doctor pleaded guilty to healthcare fraud and drug distribution charges after prescribing Ritalin and hydrocodone to an undercover investigator that had no "legitimate medical purpose," the Department of Justice announced. Kanwal also fraudulently billed Virginia Medicaid for services provided to the investigator, which were not medically necessary or not actually received. Gurcharan Singh Kanwal, 78, pleaded guilty to one count of health care fraud and one count of distributing Ritalin and hydrocodone. His plea agreement stipulates he must surrender his medical license and never reapply. He must also pay $472,500 in restitution to the Virginia Medicaid program individuals-charged-in-2018-healthcarefraud-takedown ginia-doctor-hit penalty-loses-licenseafter-admitting-illegally-prescribing-ritalin 1

2 Pharmacist convicted in compounding scheme that triggered deadly nationwide meningitis outbreak. Prosecutors said 76 people died, more than 750 sickened from tainted injections after co-owner, pharmacist ignored unsanitary conditions. Glenn Chin, 49, of Canton, Massachusetts was found guilty of racketeering conspiracy, mail fraud and introduction of misbranded drugs into interstate commerce with the intent to defraud and mislead. The outbreak occurred in 2012, when 76 patients in nine states died and 753 patients in 20 states were diagnosed with a rare fungal form of meningitis, as well as joint or spinal infections after receiving tainted injections of preservative-free methylprednisolone acetate, which had been manufactured by NECC, according to the DOJ. ews/pharmacist-convicted-compoundingscheme-triggered-deadly-nationwide-meningitisoutbreak The deadly outbreak was born when Chin manufactured three lots of the contaminated MPA, which amounted to more than 17,000 vials of medication. Chin ignored NECC's own drug formulation worksheets and standard operating procedures, insufficiently sterilizing the MPA and failing to even verify the sterilization process at all. With full knowledge of his dangerous missteps, Chin directed thousands of vials of the MPA be filled and shipped to customers across the country. At the time of this article Glenn Chin was scheduled for sentencing. ews/pharmacist-convicted-compoundingscheme-triggered-deadly-nationwide-meningitisoutbreak A Westlake man has been charged for his alleged role in a conspiracy to defraud the Cleveland Clinic out of at least $2.8 million. Wisam Rizk, of Westlake, Ohio was charged with one count of conspiracy to commit 27 counts of wire fraud and honest services wire fraud and one count of obstruction of justice. According to the DOJ, Rizk worked as chief technology officer at Interactive Visual Health Records, a company formed by Cleveland Clinic Innovations to develop a conceptual visual medical charting project into a functioning product. Rizk and others executed the incorporation of a shell company known as istarfze, which performed no actual services or provided any goods, the DOJ said. Rizk also allegedly caused ISTAR to establish a website, addresses and a mailing address in New York City so it would look like an operational business, the DOJ said, citing the indictment, and allegedly caused the submission of a bid to the Clinic to raise the price it paid for the software design and development. All these activities were allegedly conducted without Rizk disclosing his financial interest in ISTAR. eged-co-conspirator-charged-28-millioncleveland-clinic-fraud 2

3 Three New York doctors will each serve more than two years in prison for taking bribes as part of an extensive and years-long test referral scheme operated by Biodiagnostic Laboratory Services of Parsippany, New Jersey and various personnel, the Department of Justice announced. George Roussis and Nicholas Roussis of Staten Island, New York were sentenced to 37 and 24 months in prison, respectively. Ricky J. Sayegh of Scarsdale, New York will serve two and a half years in prison. All three pleaded guilty to charges of accepting bribes in violation of the Federal Travel Act. Pediatrician George Roussis and brother Nicholas Roussis, an obstetrician-gynecologist, who had Staten Island, admitted to accepting roughly $175,000 in cash payments from BLS employees and associates. BLS rewarded the brothers at their request by paying for strip club trips, including personal performances and even engaging in sex acts with George and Nicholas Roussis. The brothers in turn referred their patients' blood specimens to BLS, generating more than $1.7 million in total lab business for BLS. Sayegh practiced in Yonkers, New York as an internal medicine physician. He admitted to having received bribes totaling approximately $400,000 from BLS employees and associates in exchange for referring blood specimens from his patients to BLS. Sayegh's referrals generated more than $1.4 million in lab business for BLS, according to the DOJ. A Texas man who masqueraded as a physician on paper has been arrested and charged with engaging in an insurance fraud scheme that caused the submission of more than $25 million in false and fraudulent claims for medical services. According the DOJ,the criminal complaint states that David Williams, 54, of Fort Worth, advertised on his website between November 2012 through August 2017, getfitwithdave.com, offering in-home fitness training and therapy through his company, "Kinesiology Specialists." He identified himself as "Dr. Dave" with clients in Texas, Las Vegas, Denver, Tucson, Seattle, and Orlando, saying that he accepted most healthcare insurance coverage plans. Williams registered as a healthcare provider with the Centers for Medicare and Medicaid Services allegedly so he could bill insurance companies for services, completing the application and falsely certifying that he was a healthcare provider, enrolling as such at least nineteen times under different names or variations of his name, and his company names, falsely certifying that he was a healthcare provider in each application. w-york-physicians-get-prison-time-over-100- million-medicare-fraud w-york-physicians-get-prison-time-over-100- million-medicare-fraud rsonal-trainer-charged-posing-physician-25- million-fraud 3

4 "Williams would then bill the insurance companies as if he were a medical physician and as if he had provided care requiring medical decision making of high complexity when Williams actually provided fitness and exercise training to his clients. The DOJ also said that according to the criminal complaint affidavit, Williams recruited potential clients through various means and would meet with or speak with them over the phone, reviewing their health history and goals for their planned fitness training, and eventually assigning a trainer who typically met with the client between one and three times a week for approximately one-hour fitness training sessions. Williams would then bill insurance companies for those sessions using inaccurate codes, sometimes billing for services that neither he nor his staff, ever provided. Between November 2012 through August 2017, Williams was paid more than $3.9 million in connection with his fraudulent billing of United HealthCare Services, Aetna and Cigna, the DOJ said. The maximum statutory penalty for the charged offense is 10 years in federal prison and a $250,000 fine. A former healthcare CEO will spend nearly three and a half years in prison and pay more than $667,000 in restitution after pleading guilty to charges he stole Medicaid funds meant for nursing homes, causing living condition there to deteriorate and residents to go without sufficient food, the Department of Justice announced. John Mac Sells, 53, of St. Peters, Missouri, was the CEO of Benchmark Healthcare of Festus and a number of long-term care facilities in Missouri, Kentucky and Tennessee. He previously pleaded guilty to two counts of healthcare fraud. Sells stole Medicaid funds which were supposed to be used to provide care for elderly and disabled residents at Benchmark. Due to Sells' theft of funds, residents did not receive medication, food and needed dietary supplements. "On one occasion, the residents were only given a clear bowl of broth soup and a very small cookie. Another meal consisted of 1 to 2 ounces of lunchmeat, half of a baked potato, and a small muffin. Neither of these meals was substantial and did not meet the nutritional needs of the residents. On some occasions, Benchmark staff had to use their own money to buy food when there was no or inadequate food at the facility," the DOJ said. Sells spent the stolen Medicaid funds on personal frivolities such as $184,889 at adult entertainment and strip clubs, $11,566 at a country club, $14,614 for pet care and $4,513 at casinos. rsonal-trainer-charged-posing-physician-25- million-fraud thcare-ceo-hit penalty-prison-sentencestealing-medicaid-funds-neglecting-residents thcare-ceo-hit penalty-prison-sentencestealing-medicaid-funds-neglecting-residents 4

5 Four Houston-area hospitals will pay $8.6 million to settle allegations they took kickbacks from ambulance companies in exchange for rights to the hospitals' more lucrative Medicare and Medicaid transport referrals, the Department of Justice announced. The Anti-Kickback Statute stipulates that offering, paying, soliciting or receiving remuneration in order to cause referrals of items or services covered by federal healthcare programs is illegal. The settlement made with Hospital Corp. of America, also known as HCA resolves allegations that patients at the four hospitals got free or highly discounted ambulance transports from certain ambulance companies. In return, the hospitals referred lucrative Medicare and Medicaid business to those companies. "If not for this kickback arrangement, the four hospitals would have been financially responsible for the patient transports at significantly higher rates," the DOJ said. Since Medicaid is jointly funded by the state and federal government, the state paid some of the Medicaid claims that arose from the fraudulent arrangement, so the settlement includes more than $300,000 for the state of Texas. A New Jersey physician faces a decade in prison, tens of millions in restitution, and a hefty fine for selling his signature and signing prescriptions for patients he never saw as part of an elaborate healthcare fraud scheme that spawned $25 million in losses to state health benefits programs, the Department of Justice announced. John Gaffney, whose practice was in Margate, New Jersey, pleaded guilty to conspiracy to commit healthcare fraud for his role in the fraud scheme where he signed prescriptions for expensive compound drugs without ever seeing the patients. Per a plea agreement, Gaffney must forfeit $25,000 in criminal proceeds and pay more than $24,950,000 in restitution. He faces a maximum penalty of 10 years in prison and a $250,000 fine. hca-hospitals-pay-86-million-over-ambulancekickback-allegations hca-hospitals-pay-86-million-over-ambulancekickback-allegations -jersey-doctor-pay-nearly-25-million-overprescriptions-fraud 5

6 Novelion Therapeutics subsidiary Aegerion Pharmaceuticals will pay more than $35 million to settle criminal and civil charges related to its cholesterol drug Juxtapid. Juxtapid carries a warning label that explains it can cause serious liver and stomach issues and is only approved to treat high cholesterol in patients who have a rare genetic disease called homozygous familial hypercholesterolemia, or HoFH. Despite FDA had approval for Juxtapid's general use subject to a Risk Evaluation Mitigation Strategy to ensure that prescribers were informed of the drug's risks and preferred use for patients with a clinical or laboratory diagnosis consistent with HoFH, the government alleged Aegerion failed to give health care providers all necessary information regarding the clinical diagnosis of HoFH, which is a violation of REMS. Aegerion agreed to plead guilty to these charges and will pay a criminal fine and forfeiture of $7.2 million erion-pharmaceuticals-hit-35-million-settlementconnected-risky-cholesterol-drug-juxtapid erion-pharmaceuticals-hit-35-million-settlementconnected-risky-cholesterol-drug-juxtapid 6