Western Pennsylvania’s U.S. Attorney’s Office Participates in Largest National Medicare Fraud Takedown in History

PITTSBURGH – Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Loretta Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”

“Protecting citizens from health care fraud schemes that can devastate lives, undermine the integrity of our health care system and drive up costs for all consumers is a worthy priority for our office,” said David J. Hickton, U.S. Attorney for the Western District of Pennsylvania. “By working cooperatively with the FBI, Health and Human Services Office of Inspector General and Pennsylvania Office of the Attorney General, our office is making good on its promise to crack down on health care fraud wherever we find it.”

Following is a list of recent health care fraud prosecutions handled by the U.S. Attorney’s Office for the Western District of Pennsylvania. Only the first case is included in the nationwide sweep statistics.

June 21, 2016: An information was unsealed charging Elizabeth A. Rotto, 46, of Cranberry Township, Pa., with embezzlement related to health care. The information alleges that Rotto embezzled funds in excess of $100 that belonged to Askesis Development Group, a subsidiary of the University of Pittsburgh Medical Center. A plea hearing is scheduled for tomorrow, June 23, at 2 p.m. before U.S. District Judge David Cercone.
AUSA Robert Cessar; Federal Bureau of Investigation

June 13, 2016: An indictment was unsealed charging Daniel Garner, a dentist who practices in Pittsburgh, Pa., with distribution of Oxycodone, a Schedule II controlled substance, outside the usual course of professional practice, and omitting material information from required reports, records and other documents. According to the seven-count indictment, from Feb. 13, 2014 through June 11, 2015, Garner distributed Oxycodone on six occasions, a Schedule II controlled substance, outside the usual course of professional practice. The indictment further alleges that on Jan. 14, 2016, Garner omitted material information from an application for a Drug Enforcement Agency registration number.
AUSA Cindy K. Chung; Federal Bureau of Investigation and the Drug Enforcement Administration

June 2, 2016: Mary Ann Stewart, former chief operations officer of Horizons Hospice, LLC, pleaded guilty to one count of health care fraud. Horizons Hospice LLC, located in Monroeville, provided end-of-life hospice care to eligible patients. A significant number of patients were eligible for Medicare and Medicaid. Stewart admitted orchestrating a scheme whereby she caused her staff to place non-qualifying patients into hospice care that were not appropriate, and then recertified the patients for continued hospice care. JudgeMcVerry scheduled sentencing for Sept. 9, 2016.
AUSAs Robert S. Cessar and Nelson P. Cohen; Federal Bureau of Investigation, Pennsylvania Attorney General’s Office; Health & Human Services - Office of the Inspector General

May 31, 2016: Kari Richards of Latrobe pleaded guilty to charges of healthcare fraud and obtaining prescription drugs through fraud. Richards, while addicted to prescription pain killers, caused Highmark to pay more than $600,000 in connection with claims in which she sought treatment over a 16-month period from more than 100 hospitals in 11 states on more than 300 occasions. Through this behavior, Richards obtained approximately 190 prescriptions for pain medications, including prescriptions for Oxycodone-Acetaminophen, Hydrocodone-Acetaminophen, Hydrocodone, and Oxycodone. As part of the scheme, Richards falsely represented the circumstances of injuries, which were mainly shoulder dislocations. She also misrepresented the medications that she received and her medical history. Judge Cohill scheduled sentencing for Sept. 7, 2016.
AUSA Brendan T. Conway; Federal Bureau of Investigation

May 17, 2016: Samirkumar J. Shah was indicted on health care fraud charges. The indictment alleges that Shah knowingly and willfully executed and attempted to execute a scheme to defraud health care benefit programs, such as, Medicare, Medicaid, Highmark, UPMC and Gateway, in connection with the delivery of and payment for health care benefits, items and services.
AUSA Nelson P. Cohen; Federal Bureau of Investigation and the Pennsylvania Attorney General’s Office

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 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 and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion.

Including today’s enforcement actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings. Today’s announcement marks the second time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in this takedown.

The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide - including the U.S. Attorney’s Office for the Western District of Pennsylvania - 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 the Middle District of Florida; and agents from the FBI, HHS-OIG, Drug Enforcement Administration, DCIS and state Medicaid Fraud Control Units.

A complaint, indictment or information is merely a charge, and all defendants are presumed innocent unless and until proven guilty.