National Health Care Fraud Takedown Results In Charges Against Over 412 Individuals Responsible For Over $1.3 Billion In Fraud Losses
Largest Health Care Fraud Enforcement Action in Department of Justice History
WASHINGTON – Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including over 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving over $1.3 billion in false billings. Of those charged, over 120 defendants, including 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 against 295 providers, including doctors, nurses, and pharmacists.
Attorney General Sessions and Secretary Price were joined in the announcement by Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting Director Andrew McCabe of the FBI, Acting Administrator Chuck Rosenberg of the Drug Enforcement Administration (DEA), Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG), Chief Don Fort of IRS Criminal Investigation, Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS), and Deputy Director Kelly P. Mayo of the Defense Criminal Investigative Service (DCIS).
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 and/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. According to the Centers for Disease Control, approximately 91 Americans die every day of an opioid related overdose.
“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Sessions. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards. While today is a historic day, the Department's work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”
“Protecting our nation’s health care programs is a top priority of our Office,” said Acting U.S. Attorney Muldrow. “The coordinated actions today demonstrate our resolve to prosecute those who commit fraud against our health care programs. We will continue in our pursuit against those who violate the law to enrich themselves by defrauding our public systems and its customers by stealing from federal health care programs and the American taxpayers.”
According to court documents, the defendants 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. The number of medical professionals charged is particularly significant, 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 Medicare Fraud Strike Force operations are 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. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices of the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, and Middle District of Florida; and agents from the FBI, HHS-OIG, Drug Enforcement Administration, DCIS, and state Medicaid Fraud Control Units.
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty.
Additional documents related to this announcement will shortly be available here: https://www.justice.gov/opa/documents-and-resources-july-13-2017.
In the Middle District of Florida, 10 individuals were charged with participating in a variety of schemes.
Middle District of Florida Case Highlights
Richard Martin (56, Orlando), a former sales representative for Advanced BioHealing, Inc. (ABH), has been charged with conspiracy to violate the anti-kickback statute and to commit mail and health care fraud. According to court documents, ABH was a biopharmaceutical company that developed and commercialized bioengineered tissue products and regenerative medicine therapies. In 2006, ABH acquired the rights to Dermagraft, a bioengineered skin substitute approved for the treatment of diabetic foot ulcers, and began selling the product to treating physicians. The indictment alleges that in late 2010, Martin and others conspired to bill the Medicare Part B program as if an entire Dermagraft (38 square centimeters) was used to treat each Medicare beneficiary. In truth, Martin and others routinely divided or split the skin substitute into multiple sections for applications on multiple Medicare beneficiaries, resulting in double billing. The indictment further alleges that Martin violated the anti-kickback statute by offering and providing free office medical supplies, free Dermagraft samples, multiple meals and other consumables, and uncompensated medical office procedures and services.
Larry B. Howard (53, Oviedo), a pharmacist and the owner and operator of Fertility Pharmacy d/b/a TRICARE Wellness, has been charged with one count of conspiracy to pay and receive illegal kickbacks, two counts of paying illegal kickbacks, and two counts of money laundering. Nicole R. Bramwell (51, Apopka), a physician, and Raymond L. Stone (57, Orlando), a patient recruiter, have each been charged with one count of conspiracy to pay and receive illegal kickbacks and one count of receiving illegal kickbacks. These charges stem from their alleged roles in a $4.3 million compounding pharmacy scheme that impacted the TRICARE program.
Michael J. Anderson (64, formerly of Windermere), a managing member and operator of DMA Logistics LLC, has been charged with one count of conspiracy to commit health care fraud and wire fraud, and two counts of money laundering. These charges stem from Anderson’s alleged role in a $5.7 million compounding pharmacy fraud scheme that impacted the TRICARE program.
Podiatrist Michael Rotstein (Ocala, 55) has pleaded guilty to one count of healthcare fraud. He faces a maximum penalty of 10 years’ imprisonment and must pay mandatory restitution of approximately $1.5 million. A sentencing date has not yet been set. According to the plea agreement, when billing the Medicare and TRICARE programs Rotstein claimed that nearly half of his procedures were for the removal of skin and muscle, placing him in the top one-percent of billers nationwide for this procedure. In reality, Rotstein did not actually perform these procedures. Rather, the majority of the times that he billed for these procedures, he was actually performing routine foot care, including the clipping of toenails, which is not a reimbursable service under the Medicare or TRICARE program. Since the services performed were not reimbursable, Rotstein devised a scheme to submit claims to Medicare and TRICARE that included using a false diagnosis code and false billing code. As a result of the scheme, Rotstein received $1,504,952.67 in healthcare reimbursements to which he was not entitled.
Jack Gehring (68, Margate) has been charged with trafficking prescription opioids, primarily oxycodone, from late 2010 through 2017. According to the criminal complaint, in addition to acquiring pills himself, Gehring conspired with family members, including his brother, Patrick Gehring (59, Davie), his daughter, Tina Gehring (45, Coral Springs), and several others, including Sean Grelecki (45, Deltona). The conspirators fraudulently acquired and filled prescriptions for thousands of oxycodone pills, and other drugs, in order to illegally distribute them at black market prices of $20 per pill or more. Gehring paid for the health visits and the pharmacy costs for the oxycodone for those who fraudulently acquired pills for him. He also paid the prescription filler $600 to $900 per month, depending on the number of pills acquired. Jack Gehring then distributed thousands of oxycodone pills in Florida, Massachusetts, Connecticut, and elsewhere.
The Middle District of Florida cases are being handled by Assistant U.S. Attorneys Jay Trezevant, Thomas Palermo, Jason Mehta, Jackson Boggs, and DOJ Senior Trial Attorney Christopher Hunter of the Fraud Section.
This operation also highlights the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2.5 billion in judgments and settlements related to matters alleging health care fraud.