National Health Care Fraud And Opioid Takedown Results In Largest Enforcement Action In Department Of Justice History
WASHINGTON – Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division, Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division, Deputy Inspector General Gary Cantrell of the Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Administrator Tim McDermott of the Drug Enforcement Administration (DEA) today announced a historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses, and other licensed medical professionals.
These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, HHS-OIG, FBI, and DEA, as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic. The cases announced today are being prosecuted by Health Care Fraud and ARPO Strike Force teams from the Criminal Division’s Fraud Section, along with 43 U.S. Attorneys’ Offices nationwide, and agents from HHS-OIG, FBI, DEA, and other various federal and state law enforcement agencies.
Prior to the charges announced as part of today’s nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force program had charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion.
The Middle District of Florida (MDFL) is playing a significant role in today’s historic announcement. Collaborative efforts among federal, state, and local partners have resulting in charges against 19 defendants in the MDFL.
“Patients place their lives in the hands of medical professionals every day,” said U.S. Attorney Maria Chapa Lopez for the Middle District of Florida. In doing so, they rely upon the oath that they will put forth their best efforts to do no harm. Not only is fraud and abuse of healthcare programs illegal, but they compromise the standard of care and the public trust. We will continue to aggressively investigate these claims and hold those who violate the law accountable by all means.”
"The FBI and its law enforcement partners are determined to expose those who commit healthcare fraud." said Special Agent in Charge of FBI Tampa Division Michael F. McPherson. "We are all victims of this crime when federal healthcare programs that taxpayers fund are cheated."
“We will continue to hold medical professionals accountable for the great responsibility with which they have been entrusted, said Omar Pérez Aybar, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General. “There are no shortcuts when it comes to patient care.”
David Spilker, Special Agent in Charge at the VA Office of Inspector General stated, “The continued oversight of medical professionals who provide community care to veterans—our nation’s heroes—safeguards the integrity of VA’s healthcare programs. The VA OIG will continue to work with our law enforcement partners to hold providers who fraudulently bill CHAMPVA responsible for their unlawful conduct.”
"Unfettered greed erodes public trust, stifles our economy, and hurts hard-working Americans," stated Special Agent in Charge Brian Payne of IRS Criminal Investigation's Tampa Field Office. "Working with our law enforcement partners, we will fervently employ our unique financial investigative skills to lead the fight against white collar crime."
HEALTH CARE FRAUD CASES
The MDFL health care fraud cases included in today’s announcement involve charges brought against 12 defendants for health care fraud and violations of the federal Anti-Kickback statute. These defendants have been charged with submitting hundreds of millions of dollars in false and fraudulent claims to Medicare and other federal health care programs and employing abusive schemes that often involved telemedicine.
All of the MDFL cases described in this section are being investigated by various agencies, including the U.S. Department of Health and Human Services–Office of Inspector General, the Federal Bureau of Investigation, the Department of Veterans Affairs–Office of Inspector General, and the Internal Revenue Service Criminal Investigation.
In September 2020, Charles Burruss (51, San Diego, CA) and Ardalaan “Armani” Adams (33, San Diego, CA) were charged with conspiracy for defrauding Medicare through the submission of medically unnecessary durable medical equipment (“DME”) claims. According to court documents, Adams and Burruss paid millions in kickbacks and bribes to acquire the DME claims, which had been generated using aggressive telemarketing strategies in concert with fraudulent telemedicine involving bribed doctors who rarely spoke to the beneficiaries. During the conspiracy, Burruss, Adams, and their conspirators submitted the illegal DME claims to Medicare and other programs through a conglomerate of fraudulently established DME companies; at least 22 of those fraudulent companies were located in the MDFL. Through the MDFL companies, the conspirators submitted more than $343 million in illegal DME claims to Medicare and to the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), resulting in over $180 million in payments. The defendants have also been charged in related cases in the Southern District of California and the District of New Jersey. Each defendant faces a collective maximum penalty of 25 years’ imprisonment, if imposed consecutively, for the pending charges. The MDFL case is being prosecuted by Assistant United States Attorney Kristen Fiore.
On July 31, 2020, Richard Epstein (28, Aurora, CO) and Michael Nolan (47, Tampa, FL) each pleaded guilty, in separate cases, to conspiracy to commit health care fraud for defrauding Medicare through the submission of medically unnecessary claims for DME and cancer genetic testing (“CGx testing”). According to court documents, during the conspiracy, Epstein and Nolan ran a telemarketing company in Tampa known as REMN Management, LLC, that targeted the elderly to generate thousands of medically unnecessary orders for DME and CGx testing. The two men also created and operated Comprehensive Telcare, LLC (“CompTel”), a “telemedicine” company through which they illegally bribed medical practitioners to sign the orders regardless of medical necessity. They then illegally sold the signed orders to client-conspirators for submission to Medicare. The conspiracy resulted in the submission of at least $134 million in fraudulent claims to Medicare and other federal health benefit programs, resulting in approximately $29 million in payments. The defendants are each facing a maximum penalty of 10 years in federal prison. The cases are being prosecuted by Assistant United States Attorney Kristen Fiore and Trial Attorney Gary A. Winters of the DOJ Criminal Division’s Fraud Section.
Paul Savastano (49, Lake Worth, FL), who conspired with Epstein and Nolan, also pleaded guilty on July 31, 2020, to health care fraud conspiracy. Savastano’s role in the conspiracy was that of a broker who oversaw CompTel’s illegal delivery of thousands of the signed orders to Medicare-enrolled DME supply companies, including at least five DME companies secretly controlled by Patsy Truglia (charged separately). For his part, Savastano received a percentage of the bribes as his fee. He is facing a maximum penalty of 10 years in federal prison. The case is being prosecuted by Assistant United States Attorney Kristen Fiore.
In June 2020, Dr. Jonathan Michael Rouffe (47, Boca Raton, FL) and Dr. Richard Davidson (41, Delray Beach, FL) pleaded guilty in separate cases to conspiracy to commit health care fraud. Each faces a maximum penalty of 10 years in federal prison. According to court documents, Rouffe, Davidson, and other conspirators secretly controlled conglomerates of fraudulently established DME supply companies. During the conspiracies, the companies submitted more than $31 million in illegal DME claims to Medicare and the CHAMPVA, resulting in over $16 million in payments. The conspirators paid millions in kickbacks and bribes to acquire illegally signed doctors’ orders for DME from so-called “marketers,” who, for their part, had generated the signed doctors’ orders using aggressive telemarketing strategies in concert with fraudulent telemedicine involving bribed doctors. The cases are being prosecuted by Assistant United States Attorney Kristen A. Fiore. Additional details can be found in press release.
In August 2020, Sajid “Jay” Geronimo (41, Buena Park, CA) was charged with conspiracy to commit health care fraud. According to court documents, Geronimo owned a telemarketing company known as Cure Healthcare, Inc. that targeted the Medicare-aged population using offshore call centers that employed aggressive tactics to generate orders for DME supply companies. Cure then packaged this information into the format of doctors’ orders and bribed doctors for their signatures. Once signed, Cure sold the illegally signed doctors’ orders to client-conspirators as support for fraudulent claims submitted to Medicare and CHAMPVA, receiving more than $12 million for these illegal sales. Geronimo is facing a maximum penalty of 10 years in federal prison. The case is being prosecuted by Assistant United States Attorney Kristen A. Fiore.
On September 4, 2020, Samuel Friedman (45, Land O’ Lakes, FL) was sentenced to four years in federal prison for conspiracy to commit health care fraud. According to court documents, through his telemarketing company SKF Enterprises, LLC, Friedman targeted the Medicare-aged population using offshore call centers that employed aggressive tactics to generate orders for DME. SKF then packaged this information into the format of doctors’ orders and bribed doctors for their signatures. Once signed, SKF sold the fraudulently signed doctors’ orders to client-conspirators as support for fraudulent claims submitted to Medicare and CHAMPVA, receiving more than $3.4 million for these illegal sales. Forfeiture was ordered against his interests in real property and a bank account containing nearly $475,000. Restitution was ordered in the amount of $3.42 million. The case was prosecuted by Assistant United States Attorney Kristen A. Fiore. Additional details can be found in press release.
In September 2020, Christopher Ryan Helfrich (30, Tampa, FL) was charged with conspiracy to commit health care fraud. According to court documents, Helfrich and his conspirators owned a telemarketing operation known as A2B Insurance Solutions LLC. Helfrich also wholly owned another telemarketing company, CRH Holdings, LLC. Through these enterprises, Helfrich and his conspirators targeted the Medicare-aged population using offshore call centers that employed aggressive tactics to generate orders for DME. They then packaged this information into the format of doctors’ orders and bribed doctors for their signatures. Once signed, the conspirators sold the fraudulently signed doctors’ orders to client-conspirators as support for fraudulent claims submitted to Medicare and CHAMPVA, receiving more than $2.2 million for these illegal sales. The case is being prosecuted by Assistant United States Attorney Kristen A. Fiore and DOJ Trial Attorney Catherine Wagner of the Criminal Division’s Fraud Section.
Patsy Truglia (52, Parkland, FL) and Ruth Bianca Fernandez (37, Lauderhill, FL) were charged in a 13-count indictment alleging a conspiracy to defraud Medicare and to commit health care fraud, submit false statements to Medicare, and violate the federal Anti-Kickback statute, as well as other related charges. The indictment was unsealed with the defendants’ arrests on September 9, 2020. According to the indictment, Truglia and Fernandez conspired to create and submit fraudulent claims to Medicare for medically unnecessary DME, using aggressive telemarketing that targeted Medicare beneficiaries, bogus telemedicine encounters, and signed doctors’ orders secured using illegal bribes and kickbacks. Through the conspiracy, Truglia and Fernandez caused the submission of approximately $25 million of fraudulent claims to Medicare and other federal health care programs, including CHAMPVA, resulting in payments of approximately $10 million from the programs. The case was charged by Assistant U.S. Attorney Kristen Fiore and is being prosecuted by Assistant U.S. Attorney Jay G. Trezevant.
OPIOID FRAUD AND ABUSE DETECTION UNIT CASES
Additional MDFL cases included in today’s announcement involve charges brought against 7 defendants who are being prosecuted by the MDFL Opioid Fraud and Abuse Detection Unit (“OPFAD”), a Department of Justice program created to help combat the devastating opioid crisis that is ravaging families and communities across America and to prosecute individuals who have contributed to the opioid epidemic. OPFAD specifically focuses on opioid-related fraud and abuse by medical and health care professionals who have contributed to the prescription opioid epidemic.
Richard De La Cruz (55, Jacksonville, FL) pleaded guilty and was sentenced on August 25, 2020, to five years’ probation for making false statements relating to health care matters in connection with writing opioid prescriptions. De La Cruz was also ordered to pay restitution and $42,450 in forfeiture. According to court documents, De La Cruz, a Florida-licensed doctor, failed to conduct in-person evaluations with patients before prescribing opiates, as required by Florida law, and concealed such, when he worked for a Kentucky company that provided in-home primary care for patients. This case was investigated by the HHS-OIG. The case was prosecuted by Assistant U.S. Attorneys Kelley Howard Allen and Greg Pizzo. Additional details can be found in press release.
Hong Truong (60, Dunedin, FL), a licensed pharmacist, pleaded guilty to one count of distributing and dispensing a controlled substance outside the scope of professional practice.She was sentenced on September 23, 2020, to 30 months in federal prison, fined $500,000, and ordered to forfeit $766,819 in illegal drug proceeds. According to court documents, Truong owned and operated HP Pharmacy in Pinellas Park, where she dispensed Schedule II controlled substance prescriptions outside the usual course of professional practice, that were not issued for a legitimate medical purpose, and without resolving several red flags. Truong and the pharmacy tech she employed, Jessica Evans (34, St. Petersburg, Florida), falsely noted on the back of many prescriptions that the prescription had been verified with the prescriber’s office, when such was not the case. Evans also pleaded guilty for her role in filling the illegal opiate prescriptions and was sentenced on August 27, 2020, to 25 months in federal prison. Also charged in connection with filling false prescriptions at HP Pharmacy were Lucretia Mullan (35, St. Petersburg, FL) and Patrice Jackson (37, Bradenton, FL) who were sentenced last summer to federal prison terms of 20 months and 70 months, respectively. This case is being investigated by the Drug Enforcement Administration. The case was prosecuted by Assistant U.S. Attorneys Kelley Howard Allen and Greg Pizzo. Additional details can be found in press release.
Steven Chun (57, Sarasota, FL) and Daniel Tondre (50, Tampa, FL) were charged in a 16-count indictment unsealed on September 16, 2020. According to the indictment, Chun owned and operated a Sarasota pain management practice where he prescribed Subsys, a highly addictive and expensive fentanyl spray, to his patients in return for kickbacks paid by the manufacturer, Insys Therapeutics. Insys employed Tondre to work as a pharmaceutical sales representative for Chun’s territory. Through Tondre, Insys paid more than $275,000 in kickbacks to Chun in the form of sham speaker fees and other benefits in return for Chun prescribing higher and larger quantities of Subsys. This case is being investigated by the FBI, HHS-OIG, and the Defense Criminal Investigation Service. It is being prosecuted by Assistant U.S. Attorney Kelley Howard-Allen. Additional details can be found in press release.
An information or indictment is merely a formal charge that a defendant has committed one or more violations of federal criminal law, and every defendant is presumed innocent unless, and until, proven guilty.