Ohio 'Man' Sentenced for Allowing Criminals to Work in Home Health Care Business

02/05/201909/21/2019 ~ Ann Corcoran ~ 2 Comments

hands behind bars — The story is illustrated like this because there is apparently no photo of the scammer.

Nothing annoys me more than a story like this with no photo of the convicted ‘man’ named Ali Jama.
So I’m making an educated guess that since he lives in Columbus, Ohio***, the city with the second largest Somali population in America and that the name is a common Somali name, that he is Somali!
Someone who knows Ali Jama can tell me I’m wrong. I will be waiting!

Here is a bit of the story (STL News), taken directly from the Dept. of Justice press release on this fraudster.

OHIO NEWS: COLUMBUS, ALI JAMA, COLUMBUS HOME HEALTH CARE PROVIDER SENTENCED FOR FRAUD

COLUMBUS, Ohio – The co-owner of Alpha Star Health Care Inc. was sentenced today in federal court to 18 months in prison for running home health care fraud and tax fraud schemes.
Ali Jama, 50, of Columbus, pleaded guilty in September 2018 to one count of making false health care statements and one count of making false statements to the IRS.
[….]
According to court documents, Alpha, which was located on Westerville Road in Columbus, was a Medicare and Ohio Medicaid health care provider. In 2015 and 2016, Jama improperly billed Medicare and Medicaid by allowing unqualified health care aides to provide care.
Jama billed for services by disqualified individuals, whose criminal backgrounds prohibited them from providing direct care; and billed for services by untrained home health aides.
Further, Jama provided false documents to his tax preparer, claiming $0 in taxable income for 2013 and 2014. In fact, his taxable income for those years was approximately $167,000 and $301,000 respectively. As a result, the IRS sustained a loss of approximately $126,000 in tax liability.

Continue reading for more on his tax scams. Then check this out—a bunch of verbiage about how bad his crimes were and how “just” his sentence of 18 months is!

Ohio Republican AG Yost: His sentence is “just.”

“The public rightfully expects and trusts that those who provide health care services are competent and qualified”, said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General – Chicago Region. “The utilization of unqualified personnel coupled with the billing of federally funded health care programs for their services puts a patient’s health and safety at risk, and wastes taxpayer dollars. The OIG along with our federal and state partners will continue to identify and hold accountable those who choose to engage in this type of criminal activity.”
[….]
“This is a deliberate, coldhearted violation of the public trust,” Ohio Attorney General Yost said. “This joint investigation and prosecution was equally deliberate, and the sentence is just.”

What do you think? Is 18 months behind bars “just?” And, what are the odds he will be paying restitution amounting to hundreds of thousands of dollars! Maybe “just” would be deportation back to his homeland!

***If you are new to Frauds and Crooks, see (in my Welcome post) that a film being produced about the joys of diversity in Columbus, Ohio helped inspire me to undertake this new project!
Even if you are a subscriber and read my posts on your phone or in e-mails, visit occasionally (click here) for more information. For example, see “Trending” in the right hand side bar? Those are the posts that are the most popular with readers in recent days.

Florida: Indian-American Pain Doctor Sentenced in Medicare Fraud Case

02/04/201909/21/2019 ~ Ann Corcoran ~ 1 Comment

Last week 66-year-old Jayam Krishna Iyer was sentenced to six months in prison and ordered to repay $52,000 in false claims for Medicare reimbursement after years of dispensing dangerous pain meds to patients she didn’t even see!

Dr. Iyer leaves court — Dr. Iyer leaving court last September after admitting guilt. Expressed no remorse! https://www.wfla.com/8-on-your-side/investigations/clearwater-pain-doctor-admits-to-medicare-fraud-and-surrenders-license/1457146533

What is up with these Indian doctors, we recently had another story of an Indian pain doctor in Michigan, see here.
From News India:

Indian-American doctor in Florida sentenced to prison for fraud

An Indian-American doctor in Clearwater, Florida was sent to prison Jan. 30, after being convicted for health care fraud.
U.S. District Judge James S. Moody Jr. sentenced Jayam Krishna Iyer, 66, to six months in federal prison for committing health care fraud, and ordered Iyer to forfeit more than $52,000 in health care fraud proceeds. He also ordered her to pay restitution to the Medicare and Medicaid programs.
In addition, the court ordered Iyer to forfeit her Florida medical license, permanently excluding her from participating in the Medicare and Medicaid programs. And, Iyer agreed to surrender her Drug Enforcement Agency registration number, which had been used to prescribe controlled substances, and not to reapply for a DEA registration number for at least 20 years.
According to the press release from the U.S. Attorney for Middle District of Florida, based on court documents, Iyer owned and operated Creative Medical Center, on Druid Road East in Clearwater. The center functioned as a pain management clinic; Iyer conducted office visits and wrote prescriptions for controlled substances, including oxycodone, morphine, and fentanyl.
Beginning in July 2011 and continuing through December 2017, Iyer carried out a scheme to defraud Medicare by billing for face-to-face office visits with Medicare and Medicaid patients, when, in fact, certain patients had not gone to Iyer’s office and had not been examined by her on the claimed dates, prosecutors found.
Instead, family members of patients had visited Iyer’s office, where she issued prescriptions for Schedule II controlled substances, including oxycodone, to the family members in the patients’ names. Iyer thereby violated a Florida law requiring doctors to perform an in-person office visit and examination of each patient before issuing Schedule II controlled substance prescriptions.

More here.
Some additional information on Dr. Iyer is here at Tampa’s WFLA in September when she admitted her guilt.

Clearwater pain doctor admits to medicare fraud and surrenders license

On Aug. 31, Dr. Iyer signed an agreement with federal prosecutors in Tampa admitting guilt to one felony count of Medicare fraud that will cost her at least $51,000 in restitution in addition to giving up her medical career. She also faces a possible fine of up to $250,000 and as much as 10 years in prison.
Iyer did not express any remorse before, during or after the hearing, but in court freely admitted to stealing from taxpayers through Medicare fraud for a period of at least six years in her practice at the Creative Heath Center located at 1210 Druid Road in Clearwater.
[….]
After a public records request, the Pinellas Medical Examiner sent 8 On Your Side an eight-page list of drugs prescribed by Iyer , including fentanyl, morphine, oxycodone and dilaudid, that turned up in various Medical Examiner investigations of suspicious deaths.
None of those ME cases resulted in a criminal prosecution of Iyer. She has also faced six malpractice lawsuits filed in Pinellas civil court according to court records.
[….]
The physician who earned her medical degree in India said she is a U.S. citizen so she does not face a threat of deportation for her felony conviction.

Go here for the rest of the story and to see the news clip.

I think we have a tendency to think doctors are caring and compassionate and most of all not scammers, but these cases of medical doctors, often ‘new American’ medical doctors, and their involvement in fueling America’s prescription drug epidemic are starting to pile up. I think they need more publicity so that maybe more of you will be able to identify these frauds in your own communities. Where is the national media?

Trial Begins February 11th in Largest Medicare Fraud Bust in US

02/02/201909/21/2019 ~ Ann Corcoran ~ 4 Comments

The case involves American crooks, nursing homes, doctors, hospital workers, and over a billion in lost taxpayer dollars.
Editor: One of my readers is urging me to write something about American frauds, crooks and criminals so I’ve picked this news about a case the federal government says is its largest bust (so far). (Incidentally, the charity fraud posts like the one I wrote about yesterday are about Americans too!)
Today’s story is about former ‘one-percenter’ Philip Esformes and his father Rabbi Morris Esformes and their nursing home empire.
From the Miami Herald on Tuesday,

Once among the ‘1 percent,’ executive faces $1 billion Medicare fraud trial

Not long ago, Miami Beach executive Philip Esformes was living quite comfortably among America’s “1 percent,” raking in millions from his healthcare business, gobbling up pricey real estate and darting around the country in chartered jets.

Philip Esformes has been held behind bars since his arrest in July 2016.

Then, in a flash, his luxurious lifestyle went poof: FBI agents arrested Esformes in July 2016 and he suddenly became the poster boy for the biggest Medicare fraud case in the country. He was charged with bilking $1 billion out of the federal healthcare program for the elderly and disabled, while his vast business assets and bank accounts were frozen. Worse, Esformes, 50, was ordered held without bail at the Federal Detention Center in Miami.
Esformes was back in court Monday for one final hearing before he goes to trial by himself on Feb. 11. Once always tan and fit, he looked wan and frail as his defense team tried in vain to delay the start of trial. They sought more time to review the Justice Department’s long list of patients who prosecutors say received no services or medically unnecessary treatment at Esformes’ Miami-Dade chain of skilled-nursing and assisted-living facilities.
[….]
Esformes is standing trial alone because all of his co-conspirators have already pleaded guilty, including a physician’s assistant, Arnaldo Carmouze, and a former Larkin Community Hospital outpatient director, Odette Barcha. In January, both admitted that they recycled Medicare patients through the hospital and Esformes’ network of nursing homes and ALFs in an elaborate bribery scheme that prosecutors say was orchestrated by the healthcare executive.
Carmouze, 59, pleaded guilty to conspiring to defraud Medicare by accepting bribes for making patient referrals to Larkin and Esformes’ healthcare facilities. Barcha, 52, pleaded guilty to conspiring to pay bribes to physicians to refer patients to Larkin and receiving kickbacks herself to move patients into Esformes’ facilities.

Read the story, the list of charges is stunning, including this one:

See a timeline of more than two decades of scams involving Philip and his father Rabbi Morris Esformes here: https://www.chicagotribune.com/news/watchdog/ct-esformes-timeline-met-20161002-story.html

Esformes is also accused of referring his own network of patients to convicted healthcare-fraud offenders, including Guillermo and Gabriel Delgado, who are serving prison time. The brothers admitted swindling Medicare for mental-health, prescription-drug, and home-healthcare services, and they ultimately helped federal investigators target the Miami Beach executive.
According to the indictment, the brothers paid some kickbacks for the patients by disguising them as payments for escort services for Esformes as well as related travel and hotel expenses.
Esformes was also charged with obstructing justice because prosecutors say he plotted in 2015 with the Delgado brothers to help one of them leave Miami for Israel to avoid trial.

More here.
For those interested in more on the cheaters, see this local news story from 2016 about divorce court proceedings where Philip’s ex-wife said he believed that “money is king.”

Accused wealthy fraudster’s alleged parenting style: ‘Money is king’

The federal Medicare Fraud Strike Force was involved in the extensive investigation.

Are you keeping tabs of loved ones in nursing homes? Are they receiving treatment they don’t need while the facility bills Medicare? Or are they perhaps keeping a rehab patient longer than is necessary simply to milk the system, a system that is predicted to be insolvent by 2026?

Imagine “Medicare for all” that the Dems continue to clamor for!

Boston Trial of Indian-American Opioid Drug Executive Underway

01/31/201909/21/2019 ~ Ann Corcoran ~ 1 Comment

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.

Feds Recover $2.5 Billion from Health Care Industry Fraud in 2018

01/19/201909/21/2019 ~ Ann Corcoran ~ 4 Comments

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 firm Holland & 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 healthcare are 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.

More here.

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.