You might have caught a bit of this story on the national news because it involves a former stripper hired to help sell the drugs.
From the Boston Globe:
The federal government, which has been accused of failing to hold drug companies to account for the nation’s deadly opioid epidemic, hopes to dispel that impression Monday when the first criminal trial of pharmaceutical executives who marketed a painkiller begins. ‘New American’ John Nath Kapoor was born in India John N. Kapoor, a onetime billionaire and founder of Arizona-based Insys Therapeutics, is scheduled to go on trial in US District Court in Boston along with four former company executives on charges that they acted more like mobsters than pharmaceutical executives when they sold a brand of fentanyl, a powerful and addictive opioid.
In a trial expected to last up to three months, federal prosecutors will try to convince a jury that the five defendants paid bribes and kickbacks to physicians in a nationwide racketeering conspiracy. The payments allegedly induced doctors to prescribe Subsys, an under-the-tongue fentanyl spray approved to treat severe cancer-related pain, for patients who hadn’t been diagnosed with cancer.
The case features several explosive allegations. Prosecutors say that Insys set up a sham “speakers program” to funnel cash to doctors, adjusted payments based on how many prescriptions doctors wrote, misrepresented patients’ medical histories to dupe insurers into covering Subsys for people without cancer, and even hired a woman who was a former stripper and escort service manager as a key sales executive.
[….] The criminal case marks a rare instance of the government using the criminal Racketeer Influenced and Corrupt Organizations Act, or RICO, to go after corporate executives.The statute was approved in 1970, chiefly to prosecute organized crime figures.
[….]
Kapoor is the most prominent of the five Insys defendants. A 75-year-old shaggy-haired entrepreneur who was raised in India, lives in Phoenix, and was — until recently — on Forbes magazine’s list of billionaires, Kapoor founded Chandler, Ariz.-based Insys in 1990. For more than a decade, he largely funded it out of his own pocket.
If found guilty, Kapoor could get up to 20 years in the slammer.
Much more here.
Pharmaceutical company fraud investigations should be applauded by all Americans, on the political Left and Right, especially as it relates to the deadly opioid crisis destroying lives in middle America.
I’m guess that almost everyone knows someone addicted to pain meds?
This story reminds me to remind you to check your medicare statements carefully to be sure some doctor isn’t billing you for meds that you didn’t receive or for an amount larger than you actually were prescribed.
I’m posting just a bit of this newsfrom Columbia, SC as a follow-up to the post I wrotea few days ago about the False Claims Actand because I want to encourage readers to be proactive in looking for Medicare and Medicaid fraud where you live.
SC woman charged in alleged $9 million fraud involving autism care
Federal authorities are seeking to recover $9 million that they say a S.C. woman stole in a wide-ranging scheme involving false medical bills for treating autistic children.
Susan A. Butler, the “founder” of the S.C. Early Autism Project, is charged with overbilling Tricare and Medicaid, two federal health insurers, and making false claims about patient services. Money the insurers paid for patient care instead went for administrative costs, according to a federal grand jury indictment made public Wednesday.
You can read more about Ms. Butler, but this is the part I want you to see.
In August, the U.S. Attorney’s office in Columbia announced the Early Autism Project had paid $8.8 million to settle a civil case under the False Claims Act, alleging it had submitted false claims to Tricare and the S.C. Medicaid program for children with autism.
[….] …in the August press release, the U.S. attorney’s office in Columbia said the case began when a whistleblower, former Early Autism Project employee Olivia Zeigler, brought the allegations to the government’s attention. Under the False Claims Act, a whistleblower can file a lawsuit on behalf of the government. If the government gets involved and recovers money, the whistleblower gets part of any settlement. Zeigler was paid $435,000, the U.S. attorney’s office said.
More here.
If you want to report suspected fraud in any program involving the Dept. of Health and Human Services(Medicare, Medicaid, Refugee agency contracts (!)) go here.
Or, go back to my poston the False Claims Act and see what steps you need to take as a whistleblower filing a qui-tam case.
What can you do?
If you suspect fraud, it is your duty to do something! (And, heck you might even be rewarded as Ms. Zeigler was!). Just reading news and shaking your head about it is downright lazy! Do something, even if it is only to share the news within a circle of friends and family!
That is just the money recovered in successful health care fraud cases. Imagine how much more goes undetected! Here is the news of the Department of Justice’s annual report for 2018 for legal judgements under the federal False Claims Act. (Fascinating! the Act has been around since the Civil War.)
I know this might sound pretty boring, but you need to know about it especially as some of the successes come from “whistleblowers” who are able to make some serious money while unearthing fraud in primarily (in this case) the health care sector.
So, if you work for a doctor or hospital and notice some strange financial transactions, or see something suspicious on your Medicare statements, keep this in mind!
From a report by the law firmHolland & Knight:
In December 2018, the U.S. Department of Justice (DOJ) released its annual statistics for its civil False Claims Act (FCA) and fraud cases from the fiscal year ending Sept. 30, 2018 (fiscal year 2018). The DOJ reports it recovered $2.8 billion in settlements and judgments for Fiscal Year 2018. Of the $2.8 billion recovered in fiscal year 2018, $2.5 billion involved the healthcare industry—the ninth consecutive year that the DOJ’s civil health care fraud settlements and judgments have exceeded $2 billion.
[….]
….the FCA is used by the U.S. government to combat healthcare fraud and also serves as the primary civil remedy for redressing false claims involving federal government contracts, grants, and federally-funded programs. FCA cases can originate in one of two ways: (1) actions brought by the DOJ, or (2) actions brought by whistleblowers, known as relators, who are entitled to a portion of any proceeds recovered through settlement or judgment. In the latter actions, called qui tam actions, the case is filed under seal and the DOJ is given a period of time to evaluate the allegations and decide whether to intervene (i.e. take over the case). If DOJ declines to intervene, the relator may proceed with the action and potentially receive a greater cut of the recovery.
[….]
…in the healthcare industry newly brought qui tam cases are down while non-qui tam cases are slightly up.
[….]
The increase in government-initiated healthcare cases may be attributable to enforcement initiatives such as the nationwide Medicare Strike Force Teams. These teams, which are scattered throughout the United States, focus on criminal and civil health care fraud.
Feds are increasing the number of US Attorneys in key hot spots!
The trend line for government-initiated FCA actions should increase over the next few years. DOJ recently added a cadre of new affirmative civil enforcement attorneys, whose role will include initiating cases under the FCA. The new Assistant United States Attorneys (AUSAs) are being placed throughout the country—and offices where there is a hotbed of government contracting and healthcareare receiving more than one new AUSA. While most U.S. Attorney’s Offices will receive one additional AUSA for affirmative civil enforcement, DOJ announced that offices such as Colorado, Middle District of Florida, Southern District of Florida, Massachusetts, New Jersey, Eastern District of New York, Southern District of New York, and Eastern District of Virginia, would receive two.
This got me thinking. Have you seen any funny money business going on with the US Refugee Admissions Program and the Dept. of Health and Human Services contractors?
If so, think about this avenue to bring attention to possible fraud! You might actually make a few bucks in the process!
Afterthought: I need to be sure to let new readers know why I write this blog, here is my “welcome” post from January first.
This is an update of the story I posted two weeks ago, here. Dr. Rajendra Bothra
Dr. Rajendra Bothra had not been granted bail at the time because of a fear that he would flee to his native India. But, reporter Robert Snell at theDetroit News, who has been following the case closely, says Bothra was granted bail on Tuesday—believed to be a new record high.
You know we keep talking about migrants bringing drugs across our southern border when in fact “new American” doctors are allegedly dispensing them like Pez candy!
(And, likely ripping off US taxpayers to boot!)
Judge frees doctor on record-setting bond in opioid case
Detroit — The accused architect of a nearly $500 million health care fraud could leave jail within days after being freed on a record-setting $7 million bond Tuesday.
U.S. District Judge Stephen Murphy granted the bond for Dr. Rajendra Bothra, 77, of Bloomfield Hills, despite the government’s concern the doctor has hidden money that could bankroll an escape to his native India.
The amount shattered the previous record-high bond of $4.5 million granted two years ago to Dr. Jumana Nagarwala, who is charged in the nation’s first case involving female genital mutilation.
Bothra, the lead defendant in one of the largest health care fraud cases in U.S. history, must liquidate an $8.5 million retirement account to cover the bond, a process that could take three days. Bothra will be released on home confinement and tracked by a GPS tether and must identify all assets under penalty of perjury.
His wife and daughter, who attended the hearing Tuesday, will surrender their passports to alleviate concerns that the family might flee while Bothra awaits trial in July.
[….] Prosecutors have been unable to pinpoint Bothra’s net worth, which could be as high as $35 million.Assistant U.S. Attorney Brandy McMillion noted that Bothra owns a real-estate company that owns 22 properties across Metro Detroit, including $2.8 million worth of condominiums and commercial buildings in downtown Royal Oak.
Continue here. There is much more including photos of the real estate holdings Bothra may have purchased with funds from his alleged fraud scheme.
Some are, but maybe not your local friendly, helpful health professional! You can bet the drug industry and the Medicare fraudsters were happy to see Sessions out as Attorney General
A little over six months ago, then Attorney General Jeff Sessions announced a major federal crackdown on doctors, pharmacists and other health providers for fueling the opioid crisis and using your Medicare and Medicaid dollars to line their pockets.
Here is a bit of one story about Sessions’ announcement.
From State NewsJune 28, 2018:
Federal agencies on Thursday announced charges in what Attorney General Jeff Sessions called “the largest health care fraud takedown in American history,” an investigation into over $2 billion in alleged fraud by doctors, pharmacists, and nurses.
Many of the allegations centered on illegitimate opioid prescriptions. The Justice Department charged 162 defendants, including 76 doctors, for their roles dispensing opioids and narcotics, the result of investigations spanning 30 state Medicaid programs and numerous enforcement agencies.
[….]
“Some of our most trusted medical officials, professionals, look at their patients, vulnerable people suffering from addiction, and they see dollar signs,” Sessions said.
The alleged fraud and false billings collectively accounted for 13 million illegal opioid dosages, the Justice Department said, and also included 23 pharmacists and 19 nurses.
The Department of Health and Human Services also announced that since July 2017, it has excluded over 2,700 individuals and 587 providers from Medicare and Medicaid “for conduct related to opioid diversion and abuse” — including 67 doctors, 402 nurses, and 40 pharmacy services.
Here are a couple of more recent cases of Pharmacy fraud
Don’t miss my post from last week about Pharmacist Haytham “Tom” Fakihin Dearborn, Michigan. Florida Fraudster
From a Justice Department Press release in December, here.
The owner of a Miami, Florida-area pharmacy who caused Medicare to pay more than $8.4 million over a six-year period for prescription drugs that were never provided to beneficiaries was sentenced today to 87 months in prison.
[….]
Antonio Perez Jr., 48, of Miami Beach, Florida, was sentenced by U.S. District Judge Federico A. Moreno of the Southern District of Florida, who also ordered Perez to pay $8,415,824 in restitution and to forfeit the same amount. Perez was ordered to forfeit four Miami-area properties worth approximately $700,000 and multiple bank accounts totaling over $250,000. Perez previously pleaded guilty to one count of conspiracy to commit health care fraud.
[….]
During the course of the scheme, Medicare paid Valles Pharmacy Discount over $32 million, of which at least $8.4 million was for prescription drugs that Valles Pharmacy never purchased and never provided to Medicare beneficiaries, Perez admitted.
The owner of Akhtamar Pharmacy will be sentenced in February.
California case ***Update*** Tatarian gets four years in the ‘big house.’ See here.
Also in December a federal jury found Pharmacist Tamar Tatarian, 39, of Pasadena, California guilty of a Medicare fraud scheme after she billed Medicare $1.3 million for drugs she never purchased or distributed.
You will be interested to see that she was one of those caught in Sessions’ big sweep earlier this year.
Tatarian, the owner of Akhtamar Pharmacy, will be sentenced next month.
Secret decoder ring at work! Tatarian must be Armenian. See the Legend of Akhtamar. My reference to Secret decoder ring comes from Ann Coulter’s ‘Adios America’ where she rightly points out that readers of news stories about crooks and criminals must search for clues about where the alleged perp might come from and how he/she got in to the country.
Exception! See yesterday’s postabout the Russians ripping off Washington staters! There the reporter actually says where those arrested were from.
I’m guess that almost everyone knows someone addicted to pain meds?
I’m posting just a bit of
What can you do?
