Owner Of Russell Springs Lab Convicted 0n Multiple Counts of Health Care Fraud

FRANKFORT, Ky. – On Friday, a federal jury convicted five former owners of PremierTox, a clinical laboratory in Russell Springs, Kentucky, of seventeen counts of health care fraud, each. The defendants were acquitted on various other counts that alleged related conduct. The seventeen counts of conviction related to medically unnecessary urine drug tests, which were submitted by the defendants’ laboratory to Anthem Blue Cross/Blue Shield with the intent to defraud the health insurer.

The evidence at trial established that Dr. Bryan Wood and Dr. Robin Peavler owned a chain of addiction treatment clinics called SelfRefind, headquartered in Danville, Kentucky. Patients at SelfRefind underwent urine drug testing as part of their treatment protocol. The urine drug testing consisted of screening tests, which indicated whether a drug was in the patient’s system, as well as more sophisticated and precise confirmation tests that were ordered when the treating physician felt it was necessary. At trial, all of the physician witnesses testified that they needed the confirmation test results by the time the patient came in for their next visit.

Miami Doctor Charged in Pain Pill Diversion and Medicare Fraud Schemes

A physician licensed in Puerto Rico, who was practicing medicine in Miami, was charged in a 16-count indictment unsealed today for his alleged participation in a multi-faceted $20 million health care fraud scheme involving the submission of false and fraudulent claims to Medicare and Medicaid and the illegal distribution of oxycodone and other controlled substances.

Roberto A. Fernandez, M.D., 51, of Miami, was charged with one count of conspiracy to commit health care fraud and wire fraud, 11 counts of health care fraud, one count of conspiracy to defraud the United States and pay and receive health care bribes and kickbacks, one count of conspiracy to distribute controlled substances and two counts of distribution of controlled substances. Fernandez was arrested on March 22, 2017, and made his initial appearance today before U.S. Magistrate Judge Andrea M. Simonton of the Southern District of Florida.

Florida Home Health Owner Charged in $15 Million Medicare Fraud Scheme

A South Florida home health care owner was charged in an indictment unsealed today for his alleged participation in a $15 million health care fraud scheme involving fraudulent claims for home health services.

Yunesky I. Fornaris, 38, of Miami, was charged with one count of conspiracy to commit health care fraud and wire fraud, two counts of health care fraud and one count of conspiracy to defraud the United States and pay health care kickbacks. Fornaris was arrested today and made his initial appearance before U.S. Magistrate Judge William C. Turnoff of the Southern District of Florida

The indictment alleges that from in or around April 2010 through July 2016, Fornaris and his co-conspirators hid their ownership in Elite Home Care LLC (Elite), a Miami-area home health clinic, in the name of a nominee owner in an effort to conceal their participation in the fraudulent scheme. According to the indictment, Fornaris and his co-conspirators allegedly submitted false and fraudulent application documents, causing Medicare to give and continue to reauthorize Elite’s Medicare provider number. As a result, the number enabled Fornaris and his co-conspirators to allegedly submit fraudlent claims for services that were not medically necessary or never provided.

Home Healthcare Workers and Patients Charged Fraudulently Billing Medicaid

St. Louis, MO – Six area home health care workers and patients were charged with making false statements to Medicaid regarding home healthcare services that were neither received nor provided. All of the Indictments involve allegations that the defendants made false statements in Medicaid timesheets that certain patients and workers provided or received personal care services (e.g. grooming, cleaning, feeding, and medication assistance) in the home setting during certain dates and times when, in reality, the patients or workers were actually somewhere else.

Regina Brown, 58, and James Smith, 75, both of St. Louis, Missouri, were charged by Indictment with three felony counts making false statements to Medicaid that Brown received Medicaid-funded home health care from Smith at Brown’s home. In reality, Brown was actually vacationing in New Orleans and on a cruise ship during the dates indicated on their Medicaid timesheets.

Benita Bell, 46, and Tammara Bell, 28, of St. Louis, Missouri, were charged with making four false statements to Medicaid that Benita Bell was receiving Medicaid-funded home health care during timeframes when Benita Bell was actually gambling at local casino or working as a caregiver providing others with health care and personal care services.

Metairie Doctor Pleads Guilty to Operating a Pill Mill

Acting U.S. Attorney Duane A. Evans announced that SHANNON CHRISTOPHER CEASAR, M.D., age 44, a physician and former co-owner and operator of Gulf South Physician’s Group in Metairie, pled guilty today to Counts 1, 2 and 3 of a Superseding Bill of Information.

CEASAR pled guilty to conspiracy to distribute and dispense, outside the scope of professional practice and not for a legitimate medical purpose, quantities of Oxycodone, a Schedule II drug controlled substance. CEASAR ran what was, in essence, a “pill mill,” i.e., an operation in which he prescribed controlled substances to drug seekers and drug abusers without a legitimate medical purpose and in exchange for a flat fee.

 CEASAR also pled guilty to threatening to assault or murder federal law enforcement officers with the intent to impede, intimidate or interfere with such officers while they were engaged in the performance of their official duties, or with the intent to retaliate. On or about July 20, 2016, at a time when CEASAR suspected he was under investigation, he made repeated threats to kill federal law enforcement officers, in particular officers with the Drug Enforcement Administration

Coral Gables Woman Sentenced For Skimming Medicaid Benefits From Mentally Ill

Tampa, FL – U.S. District Judge Mary S. Scriven has sentenced Ilfrenise Charlemagne (68, Coral Gables) to 33 months in federal prison for wire fraud. She pleaded guilty on November 8,

Begining in 2008, Charlemagne owned and operated Hilcrest Residential ALF, an assisted living facility in St. Petersburg for the aged and mentally ill. The majority of the funds used to operate Hilcrest came from the Medicaid and Social Security benefits of the residents. In May 2011, the Florida Agency for Health Care Administration (AHCA) forcibly closed Hilcrest after determining that the facility was heavily infested with bedbugs and roaches; that residents were found to be unkempt with evidence of confusion and disassociation; that residents were hungry and underfed; that Charlemagne failed to provide residents with a safe and sanitary living environment; and that residents were at risk of serious injury and major health problems. In October 2011, Charlemagne entered into a settlement agreement with AHCA promising not to own or operate an ALF for a period of five years.

New York Husband And Wife Defendants Convicted Of Mortgage Fraud And Medicaid Fraud

Joseph Atias and Sofia Atias were convicted of bank fraud, conspiracy to commit bank fraud and Medicaid fraud by a jury in federal court in Central Islip. The fraud was designed to, and did, defraud Bank of America of over half a million dollars.  The defendants face penalties of up to 35 years’ imprisonment, the forfeiture of $560,000, and restitution of over $700,000.  After the verdicts, Joseph Atias was remanded to custody pending sentencing by United States District Judge Denis R. Hurley.

“Through a web of lies and false documentation, these defendants stole more than half a million dollars from Bank of America and from Medicaid, which they used to line their own pockets,” stated Acting United States Attorney Rohde.