What a coincidence! Two stories came my way yesterday, one from Tennessee and the other from Pennsylvania, where whistleblowers filed cases against large companies they said were scamming the US taxpayers and were handsomely rewarded for their good work on our behalf.
Tennessee-Based Health Services Company Settles FCA Case Alleging Medicaid Fraud For $9.5 Million
The Department of Justice (“DOJ”) announced another False Claims Act (“FCA”) settlement centered around a health services company’s practice of providing unnecessary therapy services to patients in order to receive the maximum amount of reimbursement under Medicare. The $9.5 million settlement is with Diversicare Health Services Inc, a Tennessee-based company that provides nursing and rehabilitation services at 74 locations throughout the country. Diversicare’s alleged violations are similar to those in a medicaid fraud case settled by the DOJ for $15.4 million two weeks earlier concerning fraudulent Medicare reimbursements for unnecessary rehabilitation services.
The settlement resolves two separate qui tam FCA lawsuits filed by whistleblowers Mary Haggard and Bryant Fitzmorris, both former Diversicare employees. Ms. Haggard will receive a whistleblower award of roughly $1.4 million, and Mr. Fitzmorris will receive $145,350. The FCA allows private citizens who possess inside information of fraudulently billing against the United States Government to initiate a lawsuit on the Government’s behalf to recover those funds. The citizens, known as qui tam relators, are then entitled to receive a share of any damages that the Government ultimately recovers from the litigation.
Then from Whistleblower News Review (cool, a newsletter for whistleblowers) comes this story from Pennsylvania:
Guardian Elder Care Will Pay $15.4 Million to Resolve Allegations of Medicare Fraud – Whistleblowers Will Receive $2.8 Million
Guardian Elder Care Holdings Inc. and a list of related entities, including Guardian LTC Management and Guardian Rehabilitation Services (collectively, Guardian), have agreed to pay $15.4 million to settle a False Claims Act lawsuit. According to the complaint, Guardian billed government healthcare programs for medically unnecessary services. The company allegedly defrauded both Medicare and the Federal Employees Health Benefits Program.
Pennsylvania-headquartered Guardian operates over 50 nursing facilities in Pennsylvania, Ohio, and West Virginia. According to the whistleblower lawsuit filed by two rehab managers who worked at a Guardian facility in Carlisle, Guardian caused some of its facilities in all three states to bill the government for medically unnecessary services, at the highest level of Medicare reimbursement, solely to maximize profits.
The whistleblower complaint resolved by the $15.4 million settlement was filed under the False Claims Act (“FCA”). Under the FCA, whistleblowers with original information about a fraud can come forward and become eligible for an award ranging between 10 and 30 percent of any resulting recovery. The two whistleblowers in this case, Philippa Krauss and Julie White, will share a $2.8 million award.
How many more companies are ripping off US taxpayers via Medicare and Medicaid fraud? I bet a lot. So if you work for one and suspect fraud, check into becoming a whistleblower—it is the patriotic thing to do!
I have a bunch of posts about other successful whistleblowers,see here.
Some of the headlines call Moses deGraft-Johnson a “Tallahassee doctor,” but African media doesn’t pull punches and refers to him as a “Ghanaian doctor.”
Tallahassee doctor indicted for more than $23M in healthcare fraud
TALLAHASSEE, Fla. (WCTV) — A federal grand jury has indicted a Tallahassee doctor, accusing him of more than $23 million in healthcare fraud.
According to court documents, Moses deGraft-Johnson owned and operated the Heart and Vascular Institute of North Florida since September 2015. Kimberly Austin – his office manager – was also indicted.
Duel citizen Moses deGraft-Johnson benefited the US economy! NOT!
Federal prosecutors said in court Friday afternoon they believe there were more than 3,600 surgeries billed over the last five years, with 85 to 90% of them being fraudulent.
The 58 count indictment, which was unsealed Thursday, alleges deGraft-Johnson defrauded Medicare and Medicaid by billing them for dozens of procedures that he never performed.
A detailed list shows each of the claims was for more than $21,000. Federal prosecutors said in court that the amount of money that was improperly billed reached $23 million.
A later motion alleges deGraft-Johnson’s calendar showed he performed 14 surgeries in one day.
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The indictment contends deGraft-Johnson wasn’t even in the United States on some of those days, but rather was traveling to Madrid, London and other cities in Ghana and China.
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Culture of corruption? Since we have had so many fraud and crime stories perpetrated by Nigerians, I figured I would use this map to show you where both Ghana and Nigeria are located.
Federal prosecutors requested in court Friday that deGraft-Johnson be detained until his trial, saying the doctor poses a “serious risk of flight.”
Prosecutors contend deGraft-Johnson is a naturalized U.S. citizen born in Ghana. They say he has “the motive, the means and the opportunity to flee from the United States to Ghana.”
According to prosecutors, he has two passports, both showing that he has dual citizenship for the United States and Ghana.
Unlimited hubris!
Prosecutors also contend that deGraft-Johnson has stated his ultimate long-term professional goal is “to be the President of Ghana.”
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Court documents indicate deGraft-Johnson deposited more than $32 million in health care funds into his bank account between November 2015 and August 2019. Prosecutors say that the majority of funds were transferred to other accounts.
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At one point, deGraft-Johnson told federal agents he had no cash that was not in a bank, but agents found $40,000 cash at one of his residences.
“This suggests that there may be other cash hoards in any of Defendant’s five other residences,” prosecutors wrote.
The doctor’s other residences are located in Miami, Manhattan, Hampton and Texas, prosecutors said in court.
Prosecutors also detailed lavish spending, including millions spent on Tiffany and Cartier jewelry, two Mercedes, and the recent leases of a Ferrari and a Lamborghini.
Honestly, I think Trump is making a big mistake not highlighting some of the major Medicare and Medicaid fraud prosecutions his administration is undertaking.
At every rally he should tell a story or two about how they caught some big crooks stealing from middle class Americans!
To be fair and balanced he could throw in a few American fraudsters along with the ‘new American’ ones!
Florida? Texas? Michigan? California? Which state has the most fraudulent medical practitioners?
Is the word out all over the world for foreign docs to head to the Detroit area and set up scams to rip-off American taxpayers? It seems that way considering the number of cases of fraud I’ve reported from Michigan.
See this post about Opiod pushing docs in Michigan because they aren’t just ripping us off financially, but hurting Americans as well.
Metro Detroit physicians found guilty of defrauding Medicare, prescribing unnecessary opioids
Four Metro Detroit physicians were found guilty of health care fraud for their roles in a scheme to administer unnecessary back injections to patients in exchange for prescriptions of medically unnecessary opioids.
Officials said patients were required to get the injections in order to get the prescriptions. Some of the opioids were resold by drug dealers.
Spilios Pappas, 62, of Lucas County, Ohio, Joseph Betro, 59, of Oakland County, Michigan, Tariq Omar, 62, of Oakland County, Michigan, and Mohammed Zahoor, 53, of Oakland County, Michigan, were each found guilty of one count of conspiracy to commit health care fraud and wire fraud, and one count of health care fraud.
“These physicians subjected patients to medically unnecessary injections to reap millions in fraudulent billings. Worse still, they incentivized those treatments by offering opioid prescriptions in sky-high dosages meant for the terminally ill,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “Today’s verdict shows that the Department will root out physicians who let dollar signs rather than medical need drive their treatment of patients.”
Evidence at trial showed that from 2008 to 2016 Pappas, Betro, Omar and Zahoor worked at numerous medical clinics in Michigan and Ohio, which were operated under the name of the Tri-County Group (Tri-County) and owned by co-conspirator Mashiyat Rashid.
While working at Tri-County they engaged in a scheme to defraud Medicare of over $150 million by billing for medically unnecessary facet joint injections, unnecessary urinary drug screens, home health and more.
Officials said they offered prescriptions of oxycodone 30 mg to patients who were in pain, drug dealers, or opioid addicts. Those patients were forced to submit to unnecessary facet injections for the prescription.
The four defendants were all ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections, even though they only worked a few hours a week. The defendants practice was described during trial as an assembly line, where the four defendants earned anywhere from $1,100 to $3,500 an hour for performing the injections.
Seniors: If you are seeing a doctor, especially for pain medications and you see something suspicious, report it to Medicare.gov. Check your Medicare statements carefully. One friend who was receiving pain meds told me that her doctor had billed Medicare for a much larger amount than she was prescribed. Maybe by mistake? But, best to report anything suspicious!
“Patients were put through unneeded anxiety and pain so the doctor could make millions! “
(US Attorney Ryan K. Patrick)
The Justice Department calls what Jorge Zamora-Quezada did “heinous.”
It didn’t take long to figure out that the convicted Texas doc was from Mexico, see here.
So much for those ‘new Americans’ who are in our country for a better life! This one sure had a better life (for awhile) as he supposedly benefited the US economy (not!).
Texas Doctor Found Guilty for Role in $325 Million Health Care Fraud Scheme Involving False Diagnoses of Life-Long Diseases
A federal jury found a Texas rheumatologist guilty today for his role in a $325 million health care fraud scheme in which he falsely diagnosed patients with life-long diseases and treated them with toxic medications on the basis of that false diagnosis.
Following a 25-day trial, Jorge Zamora-Quezada, M.D., 63, of Mission, Texas, was convicted of one count of conspiracy to commit health care fraud, seven counts of health care fraud, and one count of conspiracy to obstruct justice. Zamora-Quezada is expected to be sentenced on March 27, 2020, by U.S. District Judge Ricardo Hinojosa of the Southern District of Texas, who presided over the trial.
Attorney Michael Watts holds a poster while talking about charges against Dr. Jorge Zamora-Quezada at a news conference Monday, May 21, 2018, at the Hidalgo County Courthouse in Edinburg. You will see in this story that he was raising sons to follow in his footsteps by becoming doctors too! https://www.themonitor.com/2018/06/15/embattled-doctors-son-no-bond-left-patients-in-limbo/
“The conduct in this case was heinous. Dr. Zamora-Quezada falsely diagnosed vulnerable patients, including the young, elderly, and disabled, with life-long diseases requiring invasive treatments that those patients did not in fact need,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “Today’s guilty verdict shows that the Department of Justice will work tirelessly to protect the public from unscrupulous medical professionals who greedily line their own pockets at the expense of their patients’ health and safety.”
“As evidenced by the length of trial, this was a massive investigation into one of the worst medical fraudsters,” said. U.S. Attorney Ryan K. Patrick of the Southern District of Texas.“Unnecessary medical tests to create millions of dollars of false billing is as bad as it gets. Patients were put through unneeded anxiety and pain so the doctor could make millions. He won’t need it where he’s headed.”
“The guilty verdict against Dr. Zamora-Quezada ensures he will pay a steep price for his unthinkably callous and cruel criminal conduct, committed for the sheer sake of greed,” said Special Agent in Charge CJ Porter of the Office of Inspector General for the U.S. Department of Health and Human Services (HHS-OIG). “The abhorrent conduct in this case, which resulted in harm to unsuspecting patients, only serves to deepen the dedication of HHS-OIG agents and our law enforcement partners to pursue, prosecute, and exclude bad actors in the Medicare and Medicaid programs.”
“Rarely do we see such an egregious case of health care fraud, where so many patients received years of unnecessary and debilitating treatments, which were rendered out of sheer greed,” said Special Agent in Charge Christopher Combs of the FBI’s San Antonio Field Office. “The FBI is committed to seeking justice for each and every victim who suffered immeasurable harm at the hands of these defendants. The public deserves to be able to seek medical care without fear of being falsely diagnosed and given toxic medications they don’t need. We will relentlessly pursue those who would enrich themselves at the expense of those most vulnerable in our community.”
According to the evidence presented at trial, Zamora-Quezada falsely diagnosed a large number of patients with rheumatoid arthritis, a life-long, incurable disease – and treated them with toxic, medically unnecessary medications like chemotherapy drugs on the basis of that false diagnosis.
Many patients, including patients as young as 13, suffered physical and emotional harm as a result of the false diagnoses, chemotherapy injections, hours’ long intravenous infusions, and other excessive, repetitive and profit-driven medical procedures. The evidence further showed that to obstruct and mislead a federal grand jury investigation, Zamora-Quezada falsified medical records. Zamora-Quezada operated medical practices throughout South Texas and San Antonio. He traveled to his various offices on his private jet and in his Maserati.
There must be ads worldwide—become a doctor and go to the US to rip off dumb Americans. I hope you are checking your medical professionals carefully.
By the way, I think Texas is giving the frauds and crooks in Michigan and Florida a run for their money!
“[A]fter arriving in the United States from Cuba on a raft seeking refuge and a better life…they proceeded to build a vast empire of fraud.”
I could not find a photo of the Cuban crooks.
Here is the news directly from the US Justice Department, and I must say this is one of the better press releases I’ve seen from the feds especially for its mention of the fact that the Cuban crooks were refugees who then took advantage of us. (Immigration history is rarely mentioned.)
(Thanks to one of my many readers who share tips with me.)
We gave them an opportunity for a good life, they ripped us off and now we must pay for their incarceration!
Husband and Wife Sentenced to Prison for Roles in $38 Million Health Care Fraud and Wire Fraud Scheme
Rodolfo Pichardo, 71, of Hialeah, Florida was sentenced to more than 15 years in prison for masterminding a $38 million health care fraud and wire fraud scheme. His wife Marta Pichardo, 66, was sentenced to 8 years in prison for her role in the scheme.
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Rodolfo Pichardo and Marta Pichardo previously pled guilty to conspiracy to commit health care fraud and wire fraud. On December 4, 2019, Rodolfo Pichardo, was sentenced by U.S. District Judge Rodolfo A. Ruiz to 188 months in prison, to be followed by 3 years of supervised release. He was ordered to pay $33,841,576 in restitution. Today, Marta Pichardo was sentenced by Judge Ruiz to 96 months in prison, to be followed by 3 years of supervised release. She was ordered to pay $10,482,178 in restitution.
According to court documents, after arriving in the United States from Cuba on a raft seeking refuge and a better life, the Rodolfo Pichardo and his wife Marta Pichardo settled in Miami-Dade County, Florida where they proceeded to build a vast empire of fraud, consisting of at least six fraudulent home health agencies, three fraudulent therapy staffing companies, and two fraudulent pharmacies. Each of these entities purportedly provided home health services, therapy services, and prescription drugs, respectively, to qualified Medicare beneficiaries, though in fact and as both Rodolfo and Marta Pichardo knew, they did not.
From May 2010 through September 2016, the Pichardos and their co-conspirators used this empire to submit more than $38 million in false and fraudulent claims to Medicare, for which the trust-based program then paid out more than $33 million.
Fueled their lavish lifestyle with your money!
The Pichardos then used this money to purchase multiple properties, high-end vehicles, expensive jewelry, plane tickets, vacations, cosmetic procedures, and more, both for themselves and their family members.
As part of the scheme, Rodolfo Pichardo offered and paid kickbacks, both by cash and by check, to numerous patient recruiters, in exchange for the referral of Medicare beneficiaries to home health agencies that he owned. The conspirators also offered and paid cash kickbacks to owners and operators of multiple Miami-Dade medical clinics, in return for acquiring medically unnecessary home health prescriptions for the recruited Medicare beneficiaries. These prescriptions were then used by the Pichardos’ various home health agencies and pharmacies to bill Medicare for purported services and pharmaceutical drugs that were provided to allegedly qualified Medicare beneficiaries
During the long-running scheme, the Pichardos took several calculated steps to conceal the fraud and avoid detection, including using nominee owners, changing names and locations of their fraudulent entities, and creating shell companies to conceal the receipt of the fraud proceeds, hide assets and transactions, and divert proceeds for both personal use and to further the fraud.
So much for Michael Bloomberg’s New American Economybuilt on immigrant entrepreneurs.
As I have said before, the President should work some of the fantastic fraud busts his Justice Department is exposing into each rally he attends. He could direct his staff to find one or two relevant to whatever state he is visiting.
I think Florida fraudsters might outnumber Michigan schemers here at ‘Frauds and Crooks’, but I’ll check my archives tomorrow on this blogs first anniversary!
Don’t forget to check in at Refugee Resettlement Watch which has been taking most of my attention in recent weeks!
The Department of Justice (“DOJ”) announced another False Claims Act (“FCA”) settlement centered around a health services company’s practice of providing unnecessary therapy services to patients in order to receive the maximum amount of reimbursement under Medicare. The $9.5 million settlement is with Diversicare Health Services Inc, a Tennessee-based company that provides nursing and rehabilitation services at 74 locations throughout the country. Diversicare’s alleged violations are similar to those in a medicaid fraud case settled by the DOJ for $15.4 million two weeks earlier concerning fraudulent Medicare reimbursements for unnecessary rehabilitation services.
Honestly, I think Trump is making a big mistake not highlighting some of the major Medicare and Medicaid fraud prosecutions his administration is undertaking.
Rodolfo Pichardo, 71, of Hialeah, Florida was sentenced to more than 15 years in prison for masterminding a $38 million health care fraud and wire fraud scheme. His wife Marta Pichardo, 66, was sentenced to 8 years in prison for her role in the scheme.