Charges Brought Against 34 Individuals for Alleged West Coast Medicare and Medicaid Fraud Schemes Totaling $258 Million
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced today a health care fraud enforcement action in the state of California, involving charges brought against a total of 26 individuals in the Central District of California for their alleged involvement in Medicare and Medicaid fraud schemes resulting in $257 million in billings. Of those charged, 14 were doctors or medical professionals. In addition, in the states of Arizona and Oregon, eight defendants, including three licensed medical professionals, have been charged with defrauding the Medicaid program out of over $1 million. These cases were investigated by each state’s respective Medicaid Fraud Control Units
Today’s enforcement action was led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG). In addition, the operation includes the participation of various other federal law enforcement agencies and the California Department of Justice, including the U.S. Department of Labor, Office of Inspector General, the U.S. Department of Labor, Employee Benefits Security Administration, the U.S. Department of Defense, Defense Criminal Investigative Service, the Amtrak Office of Inspector General, the U.S. Office of Personnel Management, Office of Inspector General and the California Department of Insurance.
The charges announced today aggressively target schemes billing Medicare and Medicaid for services, testing and prescriptions that were not medically necessary or not actually provided to beneficiaries.
“Today’s action shows that our ability to detect and prosecute health care fraud grows more sophisticated with each passing day,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The Department of Justice is using every tool at our disposal to target the medical professionals and others who place their personal greed above the public good.”
“Corruption drains dollars from private insurers and public programs such as Medicare and Medicaid,” said U.S. Attorney Nick Hanna of the Central District of California. “This office will continue to hold accountable anyone – including medical professionals – who seek to bilk our nation’s health care system.”
“Sticking taxpayers with a bill for unnecessary healthcare services will never be tolerated,” said Special Agent in Charge Timothy B. DeFrancesca of the U.S. Health and Human Services, Office of the Inspector General. “Working closely with our law enforcement partners, our agency will tirelessly pursue physicians and others who threaten the integrity of Federal healthcare programs.”
“Health care fraud schemes cheat American taxpayers and health care programs out of millions of dollars,” said Assistant Director in Charge Paul D. Delacourt of the FBI’s Los Angeles Field Office. “With the assistance of the public, the FBI and partner agencies will continue to combat this unscrupulous criminal activity that seeks to financially exploit our healthcare system.”
“Criminal activity that drives up medical costs for Californians at the expense of vulnerable communities will not be tolerated,” said California Attorney General Xavier Becerra. “The California Department of Justice will continue to seek opportunities to work with our federal partners to not only prevent wrongdoing, but also target fraudsters and hold them accountable.”
“Health plans are tempting targets for unscrupulous individuals,” said Los Angeles Regional Director for the U.S. Department of Labor’s Employee Benefits Security Administration Crisanta Johnson. When wrongdoers victimize health plans and their participants, EBSA and its fellow enforcement agencies will take prompt, aggressive, and coordinated action to hold them accountable.”
Among those charged in Strike Force cases in the Central District of California are the following:
Ronald Weaver, M.D., 70, of Pacific Palisades, California, Sara Soulati, 49, of Santa Monica, California, John Weaver, M.D., 75, of Alhambra, California, Ronald Carlish, M.D., 78, of Pacific Palisades, California, Howard Elkin, M.D., 68, of Whittier, California, Wolfgang Scheele, M.D., 79, of Los Angeles, California, and Nagesh Shetty, M.D., 74 of Huntington Beach, California, were charged for their alleged participation in an approximately $135 million scheme to defraud Medicare through medically unnecessary cardiac treatments and testing through Global Cardio Care of Inglewood, California. The case is being prosecuted by Trial Attorneys Emily Z. Culbertson and Alexandra Michael of the Criminal Division’s Fraud Section.
Hilda Haroutunian, 59, of Sun Valley, California, Keyvan Amirikhorheh, M.D., 60, of Seal Beach, California, Lorraine Watson, 56, a physician’s assistant, of Valley Village, California, Noem Sarkisyan, 63, of North Hollywood, California, and Edmond Sarkisyan, 40, a medical assistant, of North Hollywood, California, were charged for their alleged participation in an approximately $10 million scheme to defraud the Family Planning, Access, Care and Treatment (Family PACT) program administered by Medi-Cal, the California Medicaid program, through fraudulent claims for family planning services, testing and prescriptions for non-existent patients submitted through Los Angeles Community Clinic, in Los Angeles, California, and associated diagnostic testing laboratories and pharmacies. The case is being prosecuted by Trial Attorney Alexis D. Gregorian of the Fraud Section.
Antonio Olivera, 78, of Downey, California, Emelita Cephass, 57, of Downey, California, and Martin Canter, 70, of Rancho Palos Verdes, California, were charged for their alleged participation in a hospice kickback scheme. Olivera was also charged for his alleged participation in a scheme to defraud Medicare, all involving Mhiramarc Management LLC, a hospice located in Downey, California. In a separate case, John O’Brien, hospice owner, was charged with health care fraud conspiracy for his alleged role in the fraud scheme. The cases are being handled by Trial Attorney Justin P. Givens of the Fraud Section.
Among those charged in cases being handled by the U.S. Attorney’s Office for the Central District of California are the following:
Navid Vahedi, 40, of Los Angeles, California, Vahedi’s pharmacy “Fusion Rx Compounding Pharmacy,” and Joseph S. Kieffer, 39, of Los Angeles, California, were charged for the alleged participation in a fraud and illegal kickback scheme. Fusion Rx produced compounded drugs, which are specially tailored medications that may be prescribed by a physician when the FDA-approved alternative does not meet the patient’s needs. Vahedi, the operator of Fusion Rx, and Kieffer, a marketer, allegedly paid commissions to marketers and some patients to obtain medically unnecessary compounded drugs to allow Fusion Rx to bill health care providers for those compounded drugs, many of which were reimbursed at rates much higher than average medications. To encourage patients to continue seeking the compounded drugs, Fusion Rx allegedly failed to charge copayments to patients. However, to avoid the scheme being uncovered in an audit, they also allegedly directed Fusion Rx staff to use gift cards to pay the patients’ copayments for them so that it would appear they made the required copayments. This conduct allegedly resulted in approximately $17 million in losses to health care providers while the defendants spent substantial sums of money on themselves, including Vahedi’s purchase of a 1963 Ford Mustang Cobra. Also charged in a related case was Joshua Pearson, 40, a marketer, of St. George, Utah, for his alleged receipt of illegal kickbacks from Fusion Rx, Vahedi, and Kieffer for patient referrals for compounded drugs. The cases are being prosecuted by Asssitant United States Attorneys Ashwin Janakiram and Alexander Schwab of the Major Frauds Section and Assistant United States Attorney Jonathan Galatzan of the Asset Forfeiture Section.
Amir Friedman, 54, an anesthesiologist, of Calabasas, California, was charged for his alleged participation in a conspiracy to commit honest services mail and wire fraud and Travel Act violations involving approximately $800,000 in kickbacks for compounded pharmaceutical drugs involving New Age Pharmaceuticals, Inc., located in Beverly Hills, California. The case is being prosecuted by Assistant United States Attorney Ashwin Janakiram.
Susan H. Poon, D.C., 54, a Southern California chiropractor out of Dana Point, California, was charged for her alleged participation in an approximate $2 million scheme to defraud Anthem, Aetna, and other Blue Cross Blue Shield Association affiliates. Through this scheme, Poon allegedly submitted false and fraudulent claims for chiropractic services never provided, medical diagnoses never given, and office visits that never occurred. Poon also allegedly submitted false and fraudulent prescriptions to a provider of durable medical equipment—or in-home medical devices that can cost thousands of dollars each—that relied on those false prescriptions in its reimbursement claims. Employees and employee-dependents of the United Parcel Service and Costco Wholesale Corporation who allegedly never received the claimed services or sought the claimed medical equipment were named as patients in Poon’s false claims and prescriptions. The case is being prosecuted by Assistant United States Attorney Daniel S. Lim of the Santa Ana Branch Office.
Mahyar David Yadidi, D.C., a Southern California chiropractor, was charged with conspiracy to commit health care fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association health care benefit plan. Yadidi allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, San Pedro Philips Chiropractic, by offering kickbacks to patients for attending the clinic and by billing the Plan for services that were not rendered to its patients, services that were not medically necessary, and services that were provided by unlicensed employees not qualified to perform them. Yadidi allegedly continued to operate his scheme after he was terminated as an authorized provider by the ILWU-PMA Plan. Ivan Semerdjiev, D.C., a chiropractor working for Yadidi, and Julian Williams, a personal trainer working for Yadidi, were also both charged in connection with this fraud conspiracy. In total, Yadidi, Semerdjiev, and Williams submitted almost $5 million to the ILWU-PMA Plan in allegedly fraudulent claims. The case is being prosecuted by Assistant United States Attorney Alex Wyman.
Darren Hines, D.C., a Southern California chiropractor, was charged with health care fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association health care benefit plan. Hines allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, Advanced Alternative Health, by billing for services not rendered and services being provided by unlicensed employees who were not qualified to perform them, all after Hines was terminated as an authorized provider by the ILWU-PMA Plan. Hines submitted over half a million dollars in allegedly fraudulent claims over a short period of time. The case is being prosecuted by Assistant United States Attorney Alex Wyman.
The charges and allegations contained in the indictments are merely accusations. The defendants are presumed innocent until and unless proven guilty.
The Fraud Section leads the Medicare Fraud Strike Force (MFSF), which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.