Former Louisiana Health Clinic CEO Sentenced to 82 Months in Federal Prison for Medicaid Fraud Scheme
The Medicare Fraud Strike Force (“MFSF”) is part of a joint initiative between the U.S. Department of Justice and the U.S. Department of Health and Human Services to reduce and prevent Medicare and Medicaid fraud through enhanced interagency cooperation. Its purpose is to focus on the worst offenders in fraud, in the highest intensity regions, using data analysis techniques to identify abnormal billing levels in health care fraud “hot spots,” i.e., cities with unusually high levels of billing and other fraud. The U.S. Department of Justice currently maintains 15 strike forces operating in 24 federal districts, and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $16 billion.
The Baton Rouge MFSF is comprised of the Department of Justice Fraud Division, the United States Attorney’s Office, Department of Health and Human Services - Office of the Inspector General, Federal Bureau of Investigation, and Louisiana Attorney General’s Medicaid Fraud Control Unit. Since 2009, the Baton Rouge MFSF has charged more than 100 defendants with health care fraud and related offenses, achieving a 96.8% conviction rate.
As part of the two recent National Health Care Fraud Takedowns, United States Attorney Brandon J. Fremin announced new charges against 6 individuals for health care fraud in Baton Rouge. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office, Special Agent in Charge Bryan Vorndran of the FBI’s New Orleans Field Office (FBI), and Louisiana Attorney General Jeff Landry joined in this announcement.
Kevin Bernard Hanley and Mark Thomas Allen
In the first case, the grand jury returned an indictment charging Kevin Bernard Hanley, age 42, of Prairieville, Louisiana, with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks and two counts of offering and paying kickbacks and bribes in connection with a federal health care program. Hanley is the CFO of Acadian Diagnostic Laboratories, LLC (“Acadian”), a laboratory in Baton Rouge that conducts toxicology, blood, and genetic testing.
Mark Thomas Allen, age 51, of Greer, South Carolina, was charged with one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and two counts of solicitation and receipt of kickbacks and bribes in connection with a federal health care program. Allen owned Archer Diagnostics, LLC (“Archer”), a South Carolina corporation that markets medical testing services. Allen also owned or controlled JL Management Services, LLC (“JL Management”), a Wyoming-registered corporation that purported to perform management and billing services, and also did business under the name JL Billing.
The charges stem from the defendants’ roles in a scheme to solicit medically unnecessary cancer genetic (CGx) tests from Medicare beneficiaries, have the tests approved by telemedicine doctors who did not engage in treatment of the beneficiaries, and submit claims through diagnostic testing laboratories that paid kickbacks in exchange for the referrals. Allen and his co-conspirators, through companies they controlled, solicited the tests and arranged for approvals by telemedicine providers. They then transmitted the test samples and orders to labs in Louisiana, including Acadian, where Hanley was the CFO, and elsewhere. Acadian, through Hanley and others, paid kickbacks to companies controlled by Allen and others to obtain the referrals, and submitted claims to Medicare for the tests. Acadian and other labs billed Medicare for more than $240 million.
The case was investigated by HHS-OIG, FBI, and MFCU, and was brought as part of the MFSF, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. Trial Attorneys Gary Winters, Justin Woodard and Tim Loper of the Fraud Section, and Assistant U.S. Attorney Kristen Craig of the Middle District of Louisiana are prosecuting the case.
J. Foster Chapman
In the second case, the grand jury returned an indictment charging J. Foster Chapman, age 40, of Alexandria, Louisiana, with one count of conspiracy to commit health care fraud and four counts of health care fraud.
According to the indictment, Chapman worked for various purported telemedicine companies, for which he wrote medically unnecessary orders for durable medical equipment (DME), including knee braces, for Medicare beneficiaries. The indictment alleges that an international telemarketing network lured Medicare beneficiaries into the scheme through call centers, and then sent the beneficiaries’ information to purported telemedicine companies. The indictment further alleges that Chapman, working as an independent contractor for the telemedicine companies, wrote orders for DME without speaking to the beneficiaries and in the absence of any doctor-patient relationship. Chapman concealed the fraud with falsified orders that stated, among other things, that he consulted with the beneficiaries and conducted diagnostic tests, according to the indictment. The indictment alleges that Chapman caused the submission of over $4.8 million in fraudulent claims to Medicare.
The case was investigated by HHS-OIG and FBI, and was brought as part of the MFSF, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. Trial Attorney Justin M. Woodard of the Fraud Section and Assistant U.S. Attorney Kristen L. Craig of the Middle District of Louisiana are prosecuting the case.
Victor Clark Kirk and Marilyn Brown Antwine
In the third case, the grand jury returned an indictment charging Victor Clark Kirk, age 70, of Baton Rouge, and Marilyn Brown Antwine, age 51, of Baton Rouge, each with one count of conspiracy to commit health care fraud and five counts of health care fraud.
According to the indictment, Kirk was the CEO, and Antwine was the COO, of St. Gabriel Health Clinic, Inc. (St. Gabriel), a Louisiana non-profit corporation that provided health care services to Medicaid recipients, and others. St. Gabriel is a federally qualified health center (FQHC) that contracted with the Iberville Parish School Board to provide medical services within the school district. As a FQHC, St. Gabriel could provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses, provided that such services were medically necessary, among other requirements. The indictment alleges that St. Gabriel practitioners provided character development and other educational programs to entire classrooms of students during regular class periods, and then Kirk and Antwine fraudulently billed, or caused the fraudulent billing of, these programs to Medicaid as group psychotherapy. The indictment further alleges that to facilitate the fraudulent scheme, Kirk and Antwine directed that St. Gabriel practitioners falsely diagnose students with Axis I mental health disorders. According to the indictment, during the relevant time period, St. Gabriel’s claims for purported group psychotherapy services totaled more than $1.8 million.
In March 2019, Michael Dan Gaines, a former licensed clinical social worker at St. Gabriel, pleaded guilty for his role in the fraud scheme.
The case was investigated by HHS-OIG, FBI, and MFCU, and was brought as part of the MFSF, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. Trial Attorney Justin M. Woodard of the Fraud Section and Assistant U.S. Attorney Jessica M.P. Thornhill of the Middle District of Louisiana are prosecuting the case.
In the fourth case, the United States filed a bill of information charging Casonya Williams, age 45, of Hammond Louisiana, with one count of health care fraud.
According to the information, Williams worked as a registered social worker for various behavioral health service providers. The information alleges that Williams prepared and submitted false and fraudulent progress notes and time sheets to the behavioral health service providers for services purportedly rendered to Medicaid recipients. These fraudulent documents indicated that Williams provided behavioral health services to recipients when, in fact, the services were not provided. According to the information, based on the fraudulent documents prepared and submitted by Williams for services not rendered, the behavioral health service providers submitted approximately over $176,000 in claims to Medicaid.
The case was investigated by HHS-OIG, FBI, and MFCU, and was brought as part of the MFSF, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. Trial Attorney Justin M. Woodard of the Fraud Section and Assistant U.S. Attorney Elizabeth E. White of the Middle District of Louisiana are prosecuting the case.
U.S. Attorney Brandon Fremin stated, “This month marks the 10th anniversary of the Medicare Fraud Strike Force in Baton Rouge. Strike Force teams bring together the resources of the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, the Fraud Section of the U.S. Department of Justice's Criminal Division, the U.S. Attorneys' Offices, and other law enforcement agencies, including, in Baton Rouge, the Louisiana Attorney General's award-winning Medicaid Fraud Control Unit. Over the past ten years, the team has continued working in Baton Rouge and expanded across southern Louisiana into the New Orleans area.
Just last week, the Department announced indictments in five federal districts involving fraudulent genetic cancer testing against 35 individuals for over 2.1 billion in losses in one of the largest health care fraud schemes ever charged. The Middle District of Louisiana was among the five federal districts who brought charges in this action.
It is important to note that HCF cases require significant resources and often involve well educated suspects who engage in sophisticated criminal behavior that requires investigators and prosecutors to navigate complex and nuanced areas of federal criminal law. Our collective success is possible because of the dedication and tenacity of the men and women charged with the responsibility of investigating and prosecuting those cases. Here in the Middle District you have some of the best.”
“Healthcare fraud is not a victimless crime. Whether corrupt providers engage in genetic testing schemes or other types of healthcare fraud, it’s the trust and well-being of patients and taxpayers that are at risk,” said Special Agent in Charge C.J. Porter of HHS-OIG. “Today’s arrests demonstrate our resolve to investigate bad actors and protect the patients served by vital federal health and human services programs.”
Bryan A. Vorndran, FBI New Orleans Special Agent in Charge stated, “Throughout this case, the men and women of the FBI Baton Rouge Resident Agency, along with our federal, state, and local law enforcement partners, thoroughly investigated several health care facilities and ultimately uncovered a number of violations which are being highlighted here today. I believe these cases demonstrate the unparalleled collaboration and dedication between all agencies represented within the Medicare Health Care Fraud Strike Force to protect Louisiana residents.”
“Medicaid welfare fraud jeopardizes healthcare resources for Louisiana’s most needy and steals from our State’s taxpayers,” said Louisiana Attorney General Jeff Landry. “My office and I will continue our efforts to root out this type of fraud and other criminal activity that drives up medical costs for everyone.”
NOTE: A Bill of Information is an accusation by the U.S. Attorney’s Office. The defendant is presumed innocent until and unless adjudicated guilty at trial or through a guilty plea.
An indictment is an accusation by the Grand Jury. The defendants are presumed innocent until and unless adjudicated guilty at trial or through a guilty plea.