National Health Care Fraud Takedown Results In Charges Against 601 Individuals Responsible For $2 Billion In Fraud Losses
FRESNO, Calif. — Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses, and other licensed medical professionals for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 587 providers, including doctors, nurses and pharmacists.
As part of today’s enforcement actions, U.S. Attorney for the Eastern District of California, McGregor W. Scott, announced four individuals facing health care fraud charges in Fresno.
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
U.S. Attorney McGregor W. Scott said, “As today’s announcement highlights, we are working diligently with our law enforcement partners to hold accountable those who lie and cheat in an attempt to enrich themselves off of taxpayer dollars that are meant to help those in need. The U.S. Attorney’s Office for the Eastern District of California is committed to continuing these cooperative efforts and prosecuting health care fraud cases.”
According to court documents, the many defendants charged today allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over 2 billion in fraudulent billings. Because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims, aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
The following cases in the Eastern District of California are part of today’s announcement:
Case no. 1:18-mj-100-sko
A criminal complaint filed in Fresno alleges that Hermine Hambartsumyan, 36, of Fresno, and Tem Phaphonh, 65, of Fresno, used the information of elderly Lao Medicare beneficiaries to submit false claims for durable medical equipment (DME) and physical therapy services. Phaphonh recruited the patients and gained their identification and insurance information. She then passed it to Hambartsumyan, who ran a series of DME businesses. The DME companies submitted claims to Medicare indicating that they had provided expensive orthotic braces to the beneficiaries. These claims were false because either the beneficiaries had received nothing or they had received inexpensive items for which Medicare does not reimburse. For example, one of the DME companies billed Medicare approximately $1,936 for orthotic braces including two knee braces and two ankle-foot braces for a Medicare beneficiary who had had his left leg amputated from the knee down and wore a prosthesis. The beneficiary had no knowledge of the DME company, never received the braces, and did not have a left foot or ankle on which to place an orthotic brace.
Hambartsumyan and Phaphonh also set up a health clinic in Porterville, California known as Villa Health Center LLC (VHC). Phaphonh recruited patients for this clinic for the purpose of submitting false claims, including false claims for physical therapy services. Beneficiaries received massages during their visits to VHC, and VHC billed Medicare for physical therapy services. The claims were false because Medicare requires such services be provided by trained physical or occupational therapists.
Case no. 1:18-mj-101-sko
A separate criminal complaint alleges that Gabriel Huerta, 38, of Fresno, and Natalie Corral, 38, of Fresno, were co-owners of a durable medical equipment business known as Central Valley Medical Supplies (CVMS) that falsely billed government health insurance programs for power wheelchair repairs. In many cases, CVMS did not perform the repairs, but even in the small amount of cases in which they were performed, the claims were false because the repairs were unnecessary and were not authorized by a physician, both of which are required by the programs. CVMS also billed for providing loaner wheelchairs to beneficiaries during the “repairs,” but no loaners were provided. From approximately January 2013 to June 2016, Medicare paid over $916,000 for false claims submitted under the direction of Huerta and Corral.
The Eastern District of California cases are the product of investigations by the Federal Bureau of Investigation, HHS OIG, and California Department of Health Care Services Investigation Branch. Assistant U.S. Attorney Michael G. Tierney is prosecuting the cases. A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.