Fraud Report U.S. Healthcare-Corporate Greed and Justice Intervention
Americans have been conditioned to view healthcare fraud as a crime perpetrated by Medicaid cheats, but the curtain is being pulled on corporate fraud, which costs healthcare consumers so much more than welfare opportunists. This week, criminal trials begin for executives at two different companies, Allergan’s Warner Chilcott unit, a pharmaceutical company and Johnson and Johnson, a medical device manufacturer, at the federal court in Boston.[1]The justice department decided the billions in corporate fines were not sufficiently deterring corporate misconduct in healthcare and has started to pursue criminal charges for white collar criminals who here-to-for thought they could pay a fine and walk. The individuals in the chart below have been indicted by a federal grand jury and will stand trial:
Corporate Fraud
Pharmaceutical Industry | Allergan subsidiary Warner Chilcott has already plead guilty to healthcare fraud and paid a $125,000,000 fine | W. Carl Reichel, ex-president of Warner Chilcott | Kickbacks (bribes) to healthcare providers | Applies to Atlevia, for osteoporosis and other drugs |
Medical Device Industry | Johnson & Johnson subsidiary, Acclarent | William Facteau, former CEO and Patrick Fabian, former Vice President of Sales | Promoting unauthorized use of a sinus opening device (fraud) and securities fraud for nondisclosure | Spiking sales for a balloon device used for sinus procedures by promoting it as a steroid delivery device to inflate share price |
(Division April 15, 2016)[2]
Fraud Report- Criminals in our Healthcare system
Due to the plethora of convicted criminals in healthcare, each table will show the crime by classification for 2016 and is all drawn from the U.S. Health & Human Services Fraud Report. (Services 2016)Also, only individuals working in the healthcare industry who committed the crimes are listed, not other nefarious opportunists. Also, Stark Law violations, which create fines for hospitals which have privileged financial relationships with community based physicians are not listed because that would generate an entire article.
Drug Dealers
Prescription Drug Fraud, money laundering, conspiracy | Kentucky Anesthesiologist | Convicted May 12th, Jaime Guerrero; sentenced to 100 months (8.3 years) in prison | Unlawful distribution of a controlled substance | Prescribing Hydracodone without medical necessity |
Prescription Drug Fraud, money laundering | Pennsylvania Drs. Alan Summer, Azad Khan, Keyhosrow Parsia | Indicted May 11th | Unlawful distribution of a controlled substance | Unlawful sale of Klonopin and Suboxene for cash |
Fraudulent prescriptions | Pennsylvania, Dr. John Terry | Sentenced-plea bargained January 5th | Fraudulent prescriptions | Unlawful prescriptions for oxycodone |
Fraudulent prescriptions worth $20,000,000 | California, Dr. Kenneth Johnson | Sentenced to a 108th months (9 years) prison term January 6th | Fraudulent prescriptions written out of sham medical clinic in Glendale | Pre-signed thousands of prescriptions |
Fraudulent prescriptions | West Virginia, Dr. Jose Jorge Abbud Gordinho | Plead guilty January 7th | Fraudulent prescriptions | Unlawful prescriptions for hydrocodone |
Conspiracy to distribute narcotics | New York, Dr. Kevin Lowe | Found guilty May 4, 2015, sentenced January 11, 2016 to 144 months in prison (12 years) | Owned Astramed, a clinic in the Bronx, NYC | Unlawful distribution of oxycodone |
Medicare Fraud-Overbilling or False Claims
These criminals are listed in descending order from the beginning of 2016
Defrauding Medicare of $4,500,000 | California | Hovik Simitian, sentenced to 78 months (6 ½ years) in prison, January 2nd | Included 3 clinics: Columbia Medical, Safe Health, and Life Care | Fraudulent claims |
Over billing Medicare $7,800,000 | Tennessee Nashville Pharmacy Services, LLC | Kevin Hartman, majority shareholder agreed to the plea | Over billing for Aids and HIV medications | |
Fraudulent claims of $70,000,000 | Florida | Transportation Services Providers Inc. Damian Mayol, sentenced January 8th | Included 3 clinics and involved mental health patients | Involved kickback payments and billing for unnecessary services |
Fraudulent claims, $63,000,000 | Florida | Nery Cowan plead guilty January 14th, sentenced on March 25th to 60 months (5 years) in prison | Ms. Cowan was a consultant and Medicare biller for Greater Miami Mental Health Center | Directed kickback payments and received a percentage of Medicare reimbursements |
Fraudulent claims, $375,000,000 | Texas | Patricia Akamnonu, RN sentenced to 10 years and ordered to pay $25,000,000 in restitution on January 19th | Founder of Ultimate Care Home Health Services Inc. | Fraudulent claims for home health care services |
Fraudulent claims, $57,000,000, healthcare fraud, wire fraud, conspiracy | Florida | Khaled Elbeblawy, convicted of fraud, January 22, sentenced to | Jem Home Health Care, Healthy Choice Home Health Care, Willsand Home Health Agency Inc. | Fraudulent claims for home health care services |
Medicare Fraud-Unnecessary Medical Services
False Claims | Virginia, Bostwick Laboratories | Dr. David G. Bostwick, sentenced January 8th, ordered to pay $3,700,000 fine | False claims for unnecessary services and kickbacks to physicians | Unnecessary cancer detection services |
False Claims | Nationwide rehabilitation services provider, Kindred Rehabcare | Company Agreed to pay $125,000,000 to the government on January 12th | False claims for skilled nursing facility services | False claims for unnecessary rehabilitation services |
False Claims | Illinois, convictions for officers of Mobile Doctors had already been procured | Dr. Banio Koroma, Mobile Doctors convicted of federal fraud, on January 25th, sentencing set for June 6th | Certified patients were home bound when they were not | False claims for unnecessary home health care services |
False Claims for $1,500,000 | California | Amalya Cherniavsky, owner of California Medical Equipment Supply Company | False claims for unnecessary services | Kickbacks for prescriptions for unnecessary medical equipment |
As you may have surmised, there are so many fraud cases, I have only been able to illustrate the month of January 2016 in this article, so certainly this topic needs revisiting on a regular basis. Let’s all give a big thank you to the hard working folks at the Medicare Fraud Strike Force-your government dollars working effectively to cut fraudulent waste in the healthcare system. The next time you hear someone complaining about all of the focus on fraud in the healthcare system and how it is unnecessary, feel free to refer them to this handy summary. And this is the healthpolicymaven signing off wishing you fully informed consent in all of your health care decision making.
The healthpolicymaven is a trademark of Roberta E. Winter and Praevalere Inc. Feel free to share this article virally. Roberta Winter is the author of http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
Works Cited
Division, Federal Drug Agency-Enforcement. April 15, 2016. Former Acclarent, Inc. Executives Charged with Securities Fraud and Crimes Related to Sale and Distribution of Medical Devices. United States Department of Justice Proceeding, U.S. Health and Human Services, Boston: U.S. Department of Health and Human Services. Accessed May 23, 2016. http://www.fda.gov/ICECI/CriminalInvestigations/ucm443650.htm.
Loftus, Peter. 2016. "Ex-Health Executives Go on Trial." Wall Street Journal, May 23: B1-B2.
Services, U.S. Health & Human. 2016. "Healthcare Fraud Report." Health & Human Services. Accessed May 23, 2016. http://oig.hhs.gov/fraud/enforcement/criminal/.
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