MIAMI HEALTH CARE CLINICS SENTENCED FOR HEALTH CARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Thursday, March 17, 2016

Owner of Two Miami Clinics Sentenced to 82 Months for Health Care Fraud Charges

An owner of two fraudulent medical clinics in the Miami area was sentenced to 82 months in prison today for his role in a Medicare fraud scheme that caused more than $3 million in losses.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Division and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Miami Regional Office made the announcement.

Carlos Medina, 56, of Miami, pleaded guilty before U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida to one count of conspiracy to commit health care fraud in January 2016.  In addition to his prison sentence, Judge Altonaga ordered Medina to forfeit $3,067,898.69.

According to admissions in the factual basis for his plea agreement, Medina was the owner of Doral Community Clinic Inc. and Advanced Medical of Doral Inc., however, other individuals served as the owners on the clinics’ corporate paperwork.  Medina’s clinics purportedly provided medically necessary services to Medicare beneficiaries, but in reality the clinics charged cash kickbacks ranging from $100 to $200 in exchange for prescriptions for home health care services, and some of the beneficiaries who frequented the clinics did not meet Medicare’s criteria for the prescribed services, according to the factual basis.  Some of the services prescribed by the medical professionals at Doral and Advanced Medical were never provided by the home health agencies to which the patients were referred, according to admissions in the factual basis.

The factual basis for the plea agreement states that Medina’s clinics sold prescriptions that were used to facilitate submission of false and fraudulent claims to Medicare by more than 20 home health agencies in the Miami area.  Medicare paid more than $3 million in payments as a direct result of prescriptions sold by Doral and Advanced during a period of less than two years, according to the factual basis.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida.  Fraud Section Trial Attorneys Lisa H. Miller and Jon M. Juenger are prosecuting the case.                        

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

OWNER OF MEDICAL CLINICS RECEIVES 78 MONTH PRISON TERM FOR MEDICARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Monday, January 4, 2016

Owner of Three Los Angeles Clinics Sentenced to 78 Months in Prison for Medicare Fraud

The former owner and operator of three medical clinics located in Los Angeles was sentenced today to 78 months in prison for his role in a scheme that submitted more than $4.5 million in fraudulent claims to Medicare.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Eileen M. Decker of the Central District of California, Assistant Director in Charge David Bowdich of the FBI’s Los Angeles Division and Special Agent in Charge Chris Schrank of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) Los Angeles Region made the announcement.

Hovik Simitian, 48, of Los Angeles, pleaded guilty to one count of conspiracy to commit health care fraud on Aug. 18, 2015, and was sentenced today by U.S. District Court Judge Beverly Reid O’Connell of the Central District of California, who also ordered Simitian to pay $1,668,559 in restitution to Medicare.

Simitian owned and operated Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic, three medical clinics in Los Angeles.  In connection with his guilty plea, Simitian admitted that from approximately February 2010 through June 2014, he and his co-conspirators paid illegal cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics.  Simitian also admitted that he and his co-conspirators then billed Medicare for lab tests and other services that were not medically necessary or were not actually provided to the Medicare beneficiaries, which they supported with false documentation they created.  Simitian admitted that he submitted a total of $4,526,791 in false and fraudulent claims to Medicare and Medicare paid $1,668,559 on those claims.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Central District of California.  Trial Attorneys Blanca Quintero and Alexander F. Porter of the Criminal Division’s Fraud Section are prosecuting the case.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

OWNER OF NEW YORK MEDICAL CLINICS PLEADS GUILTY TO ROLE IN $55 MILLION MEDICARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Monday, October 26, 2015

Owner of Two New York Medical Clinics Pleads Guilty to Role in $55 Million Health Care Fraud Scheme

Defendant Laundered Millions through Sham Vendors, Generating Cash to Pay Illegal Kickbacks

The owner of two medical clinics in Brooklyn, New York, pleaded guilty today to her role in a $55 million health care fraud and money laundering conspiracy.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Robert L. Capers of the Eastern District of New York, Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG’s) Office of Investigations, Special Agent in Charge Shantelle P. Kitchen of Internal Revenue Service-Criminal Investigation (IRS-CI) New York and Inspector General Dennis Rosen of New York State Medicaid made the announcement.

Valentina Kovalienko, 46, pleaded guilty before U.S. District Judge Roslynn R. Mauskopf of the Eastern District of New York to conspiracy to commit health care fraud and conspiracy to commit money laundering.  Her sentencing date has not yet been scheduled.   Pursuant to her plea agreement, Kovalienko agreed to forfeit $29,336,497.27, which amount she admitted is traceable to her criminal conduct.

According to admissions made in connection with her plea, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid.  Kovalienko also admitted that, to support the fraudulent claims, she paid occupational and physical therapists to falsify patient charts and billing records.

In connection with her guilty plea, Kovalienko admitted that she diverted funds deposited into the clinics’ bank accounts by Medicare and Medicaid to herself and her co-conspirators and to the patients to whom kickbacks were paid.  Kovalienko admitted that she did so by writing checks from the clinics’ bank accounts to an elaborate network of sham third-party vendors, purportedly in the business of providing “consulting,” “advertising” and “computer support” services, which checks she and her co-conpsirators cashed for their own benefit and to perpetuate the scheme by paying kickbacks to patients.

To date, at least 10 other individuals have pleaded guilty to participating in the scheme, including the former medical directors of both clinics, three former occupational therapists, a former physical therapist, three ambulette drivers, the owner of several of the sham vendors used to launder the money and a former patient who received illegal kickbacks.

In July and August 2014, three additional clinic managers and one ambulette driver were also charged with crimes arising from the scheme.  A trial date has not yet been set.

The case was investigated by HHS-OIG, IRS-CI and the New York State Office of the Medicaid Inspector General, and was brought as part of the Medicare Fraud Strike Force, under the supervision by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Eastern District of New York.  The case is being prosecuted by Trial Attorneys Bryan D. Fields, A. Brendan Stewart and F. Turner Buford of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,300 defendants who have collectively billed the Medicare program for more than $7 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.