Palisade man sentenced for defrauding health care programs for nuclear weapons workers and certain miners
DENVER – Anthony Paul Breaux, of Palisade, Colorado, was sentenced this morning to serve 48 months (4 years) in federal prison for health care fraud and money laundering greater than $10,000 in connection with his actions to defraud government funded health care programs meant to compensate nuclear weapons workers and certain miners. The sentence was handed down by U.S. District Court Judge Christine M. Arguello. Following his prison sentence, Breaux was ordered to spend 3 years on supervised release. The defendant was also ordered to pay restitution of over $3,500,000 to the victims of his crime. Breaux is to surrender to a Bureau of Prisons facility within 30 days of designation. To date, the government using asset forfeiture has seized approximately $1,300,000.
Breaux was indicted by a federal grand jury on September 1, 2011. He pled guilty on November 10, 2011. He was sentenced today, Friday, March 16, 2012.
According to public court documents, including the indictment and the stipulated facts contained in the plea agreement, in October 2009, Breaux created and was acting as a registered agent for Honor-Bound Healthcare Providers (HBHP), a Colorado Corporation. Breaux owned 100 percent of Honor-Bound, and was in the business of providing home health care services to patients in Colorado, Oregon, Arizona and elsewhere.
Part of Honor-Bound’s patients were nuclear weapons workers or miners, millers and transporters. In order to be reimbursed for providing medical services to these individuals, Breaux billed Energy Employees Occupational Illness Compensation Program (EEOICP) pursuant to the Radiation Exposure Compensation Act (RECA). EEOICP is a health care benefit program that provides lump-sum compensation and health benefits to eligible Department of Energy nuclear weapons workers. RECA provides coverage to eligible uranium miners, millers, and transporters. Coverage is extended under both acts to certain eligible survivors with lump-sum compensation that would have otherwise been payable to the workers. The United States Department of Labor (DOL), Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation (DEEOIC) is responsible for administering EEOICP.
From June 2010 until June 2011, Breaux, doing business through Honor-Bound, knowingly and willfully executed and attempted to execute a scheme to defraud these health care benefit programs, by submitting and causing to be submitted bills for payment, knowing those bills already had been paid. In other cases the defendant submitted invoices for services never provided. He obtained payments on the claims in part by submitting false supporting documentation. In total, the fraud the defendant perpetrated is over $3.5 million.
Breaux recruited individuals to provide care to the DEEOIC claimants he recruited who lived on the Indian Reservation in Arizona, and these individuals were family members who were already taking care of the beneficiaries. Breaux told the family members HBHP could pay them $13 per hour for care they were providing. The individuals who provided the care to the claimants in Arizona were not Registered Nurses, but Breaux billed DEEOIC at the Registered Nurse rate, $90 to $100 per hour, for the care the family members provided. Breaux knew this was not right, but he did it because of the large amount of money he was able to bring into HBHP. Breaux also forged doctor signatures he submitted to DEEOIC so that DEEOIC would authorize 24 hour, 7 day a week home health care.
On or about December 4, 2010, Breaux knowingly engaged in a monetary transaction of criminally derived property of a value of $18,235.47 by writing, delivering and causing the depositing and cashing of a check by a person Breaux used to recruit patients eligible as claimants; those funds had been derived from unlawful activity. The parties stipulated that the aggregate loss to the victims in this case was in excess of $3,400,000.
“Health care fraud is in part responsible for higher health care costs: whenever a government program is defrauded, every taxpayer is a victim,” said U.S. Attorney John Walsh. “Breaux defrauded a well-meaning program designed to address persons afflicted with serious conditions related to radiation exposure inherent in their jobs. The defendant’s conduct was reprehensible in light of the persons who should have benefitted from the funds associated with the program.”
“Today’s sentencing highlights our efforts to investigate fraud against the Department of Labor’s Energy Employees Occupational Illness Compensation Program, which was designated to provide compensation to persons who have become ill as a result of work at nuclear weapons facilities. The Office of the Inspector General and its law enforcement partners remain committed to combating these types of crimes,” stated David C. Wickersham, Special Agent in Charge for the Dallas Regional Office of the U.S. Department of Labor’s Office of Inspector General, Office of Labor Racketeering and Fraud Investigations.
“Health care fraud harms everyone as it increases the cost of legitimate health care for everyone,” said Sean Sowards, Special Agent in Charge, IRS Criminal Investigation, Denver Field Office. “This successful investigation was due to the cooperative efforts of our law enforcement partners – U.S. Attorney’s Office, the FBI and the Department of Labor Office of Inspector General.”
“FBI investigations involving health care and government fraud are among some of our highest priorities. We continue to work with our federal, state and local partners to ensure the public’s interest and taxpayer’s monies are not being abused by those interested in defrauding the system,” said FBI Denver Special Agent in Charge James Yacone. “It is our hope that today’s sentence will send a strong message to all who have been granted a trust in our health care system. On behalf of the FBI, I would like to express my sincere appreciation to our partners at the Department of Labor-OIG, the IRS-CI, and the U.S. Attorney’s Office for their hard work and long hours in bringing Breaux to justice.”
This case was investigated by the Department of Labor Office of the Inspector General (DOL OIG), the Internal Revenue Service – Criminal Investigation (IRS-CI) and the Federal Bureau of Investigation (FBI).
The defendant was prosecuted by Assistant U.S. Attorneys Jaime Pena and Tonya Andrews.