LOS ANGELES PHYSICIAN PLEADS GUILTY IN PRESCRIPTION FRAUD CASE .

FROM:  U.S. JUSTICE DEPARTMENT 
Monday, March 31, 2014
Los Angeles Physician Assistant Pleads Guilty in Two Medicare Fraud Cases

A Los Angeles physician assistant pleaded guilty today to defrauding Medicare by signing fraudulent prescriptions for durable medical equipment while working at two separate medical clinics in California.

Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, U.S. Attorney André Birotte Jr. of the Central District of California, Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Assistant Director in Charge Bill L. Lewis of the FBI’s Los Angeles Field Office and Special Agent in Charge Erick Martinez of Internal Revenue Service-Criminal Investigation (IRS-CI) made the announcement.

Erasmus Kotey, 77, of Montebello, Calif., pleaded guilty before U.S. District Judge Margaret M. Morrow in the Central District of California to one count of health care fraud and one count of conspiracy to commit health care fraud.   Sentencing is scheduled for Sept. 8, 2014.

According to court documents, Kotey was a physician assistant who worked at medical clinics in and around Los Angeles County.   From approximately November 2007 through February 2008, Kotey engaged in a scheme to commit health care fraud through his work at a clinic located at 866 North Vermont Avenue in Los Angeles.   In addition, from approximately April 2008 through December 2008, Kotey engaged in a conspiracy to commit health care fraud through his work at a clinic located at 943 South Atlantic Boulevard, Suite 218, in Monterey Park, Calif.

At both clinics, Kotey signed prescriptions and other medical documents for medically unnecessary power wheelchairs and other durable medical equipment (DME).   Kotey and his co-conspirators then sold the prescriptions to DME supply companies, knowing that the prescriptions were fraudulent.   Based on these fraudulent prescriptions, the DME supply companies then submitted false and fraudulent claims to Medicare.

Combined, the two indictments allege that fraudulent prescriptions from Kotey were responsible for approximately $7 million in false and fraudulent claims to Medicare, and Medicare paid approximately $3 million on those claims.

The cases were investigated by the FBI, HHS-OIG and the IRS and 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 for the Central District of California.   The cases are being prosecuted by Trial Attorney Fred Medick of the Fraud Section and Assistant U.S. Attorneys Kristen Williams and Cathy Ostiller of the Central District of California.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

OWNER OF MEDICAL EQUIPMENT COMPANY SENTENCED FOR MEDICARE FRAUD

The following excerpt is from the Department of Justice website:

“WASHINGTON – An owner and a patient recruiter for a Louisiana durable medical equipment (DME) company were sentenced today to 60 and 55 months in prison, respectively, for their roles in a $4.7 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the Louisiana State Attorney General’s Office.

Nnanta Felix Ngari, the owner and operator of Unique Medical Solutions, and Ernest Payne, a patient recruiter for Unique, were also sentenced by U.S. District Judge James J. Brady of the Middle District of Louisiana to serve two years of supervised release following their prison terms. Ngari and Payne’s co-conspirator, Sofjan Lamid, was sentenced today by Judge Brady to three years of probation. Ngari, Payne and Lamid were also ordered to pay $2.5 million in restitution, jointly and severally with co-defendants.

On Aug. 16, 2011, after a two-week trial, a jury convicted Ngari, Payne and Lamid of one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.

Evidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.

Between 2003 and 2009, Unique submitted approximately $4.7 million in claims to Medicare for their purported services. Medicare paid Unique approximately $2.5 million for its claims.

Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Donald J. Cazayoux Jr. of the Middle District of Louisiana; Mike Fields, Special Agent-in-Charge of the Dallas Region for the HHS Office of the Inspector General (HHS-OIG); David Welker, Special Agent-in-Charge of the FBI's New Orleans division; and Louisiana State Attorney General James Buddy Caldwell.

The case was prosecuted by former Assistant Chief Ben Curtis and Trial Attorney David Maria of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG and the Medicaid Fraud Control Unit of the Louisiana State Attorney General’s Office (MFCU), and 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 for the Middle District of Louisiana.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,160 defendants that collectively have billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.”