LOS ANGELES –
Federal charges were filed against of 25 Southern California defendants for their alleged involvement in healthcare fraud schemes that fraudulently sought over $150 million from the Medicare and Medicaid programs, as well as private insurers and union health benefit plans, officials announced Wednesday.
Fourteen of those charged in federal court in Los Angeles and Santa Ana are doctors or medical professionals.
The charges target schemes billing Medicare, Medicaid, and other health care plans for services, testing and prescriptions that were not medically necessary or not actually provided to beneficiaries.
“Sticking taxpayers with a bill for unnecessary healthcare services will never be tolerated,” said Special Agent in Charge Timothy B. DeFrancesca of the U.S. Health and Human Services, Office of the Inspector General. “Working closely with our law enforcement partners, our agency will tirelessly pursue physicians and others who threaten the integrity of Federal healthcare programs.”
“Criminal activity that drives up medical costs for Californians at the expense of vulnerable communities will not be tolerated,” said California Attorney General Xavier Becerra. “The California Department of Justice will continue to seek opportunities to work with our federal partners to not only prevent wrongdoing but also target fraudsters and hold them accountable.”
A total of 10 cases are being announced Wednesday. Those charged are:
· Dr. Ronald Weaver, 70, of Pacific Palisades; Sara Soulati, 49, of Santa Monica; Dr. John Weaver, 75, of Alhambra; Dr. Ronald Carlish, 78, of Pacific Palisades; Dr. Howard Elkin, 68, of Whittier; Dr. Wolfgang Scheele, 79, of Los Angeles; and Dr. Nagesh Shetty, 74 of Huntington Beach, who were charged for their alleged participation in an approximately $135 million scheme to defraud Medicare through medically unnecessary cardiac treatments and testing through Global Cardio Care of Inglewood.
· Navid Vahedi, 40, of Los Angeles; Vahedi’s pharmacy, Fusion Rx Compounding Pharmacy; and Joseph S. Kieffer, 39, a marketer, of Los Angeles, who were charged in a fraud and kickback scheme.
Vahedi and Kieffer, allegedly paid commissions to marketers and some patients to obtain medically unnecessary compounded drugs to allow Fusion Rx to bill health care providers for those compounded drugs, many of which were reimbursed at rates much higher than average medications.
To encourage patients to continue seeking the compounded drugs, Fusion Rx allegedly failed to collect copayments from patients.
However, to avoid the scheme being uncovered in an audit, they also allegedly directed Fusion Rx staff to use gift cards to pay the patients’ copayments for them so that it would appear they made the required copayments.
This conduct allegedly resulted in approximately $17 million in losses to health care providers, while the defendants spent substantial sums of money on themselves, including Vahedi’s purchase of a 1963 Ford Mustang Cobra.
Also charged in a related case was Joshua Pearson, 40, a marketer, of St. George, Utah, for his alleged receipt of illegal kickbacks from Fusion Rx, Vahedi and Kieffer for patient referrals for compounded drugs (Pearson is a 26th defendant in the cases being announced today).
Hilda Haroutunian, 59, of Sun Valley; Dr. Keyvan Amirikhorheh, 60, of Seal Beach; Lorraine Watson, 56, a physician’s assistant, of Valley Village; Noem Sarkisyan, 63, of North Hollywood; and Edmond Sarkisyan, 40, a medical assistant, of North Hollywood, who were charged for their alleged participation in an approximately $10 million scheme to defraud the Family Planning, Access, Care and Treatment (Family PACT) program administered by Medi-Cal, the California Medicaid program, through fraudulent claims for family planning services, testing and prescriptions for non-existent patients submitted through Los Angeles Community Clinic and associated diagnostic testing laboratories and pharmacies.
Amir Friedman, 54, an anesthesiologist, of Calabasas, who is charged for his alleged participation in a conspiracy to commit honest services mail and wire fraud and Travel Act violations involving approximately $800,000 in kickbacks for compounded pharmaceutical drugs involving New Age Pharmaceuticals, Inc., in Beverly Hills.
Susan H. Poon, 54, a chiropractor who resides in Dana Point, who was arrested today after a federal grand jury charged her in an approximately $2 million scheme to defraud Anthem, Aetna, and other Blue Cross Blue Shield Association affiliates, including the Teamsters Western Region and Local 177 health care plans.
Through this scheme, Poon allegedly submitted false and fraudulent claims for chiropractic services never provided, medical diagnoses never given, and office visits that never occurred. Poon also allegedly submitted false and fraudulent prescriptions to a provider of durable medical equipment that relied on those false prescriptions in its reimbursement claims.
Employees and employee-dependents of the United Parcel Service and Costco Wholesale Corporation, who allegedly never received the claimed services or sought the claimed medical equipment, were named as patients in Poon’s false claims and prescriptions. The case is being prosecuted by Assistant United States Attorney Daniel S. Lim of the Santa Ana Branch Office.
· Antonio Olivera, 78, of Downey; Emelita Cephass, 57, of Downey; and Martin Canter, 70, of Rancho Palos Verdes, who were charged for their alleged participation in a hospice kickback scheme.
Olivera was also charged for his alleged participation in a scheme to defraud Medicare. Both schemes involve Mhiramarc Management LLC, a hospice located in Downey.
In a separate case, hospice owner John O’Brien was charged with health care fraud conspiracy for his alleged role in the fraud scheme.
Mahyar David Yadidi, 37, a chiropractor who resides in Los Angeles, who was charged with conspiracy to commit health care fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association health care benefit plan. Yadidi allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, San Pedro Philips Chiropractic, by offering kickbacks to patients for attending the clinic and by billing the benefit plan for services that were not rendered to its patients, services that were not medically necessary, and services that were provided by unlicensed employees not qualified to perform them. Yadidi allegedly continued to operate his scheme after he was terminated as an authorized provider by the ILWU-PMA plan. Ivan Semerdjiev, 40, of Irvine, a chiropractor working for Yadidi, and Julian Williams, 44, of San Pedro, a personal trainer working for Yadidi, were also charged in connection with this fraud conspiracy. In total, Yadidi, Semerdjiev and Williams submitted almost $5 million in claims to the ILWU-PMA plan.
Darren Hines, 49, a chiropractor who lives in the Harbor City neighborhood of Los Angeles, who was charged with health care fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association health care benefit plan.
Hines allegedly defrauded the ILWU-PMA plan through his chiropractic clinic, Advanced Alternative Health, by billing for services not rendered and services being provided by unlicensed employees who were not qualified to perform them, all after Hines was terminated as an authorized provider by the ILWU-PMA plan.
Hines allegedly submitted over $500,000 in fraudulent claims over a short period of time. The case is being prosecuted by Assistant United States Attorney Alex Wyman.
“Health plans are tempting targets for unscrupulous individuals,” said Crisanta Johnson, Los Angeles Regional Director for the U.S. Department of Labor’s Employee Benefits Security Administration. “When wrongdoers victimize health plans and their participants, EBSA and its fellow enforcement agencies will take prompt, aggressive, and coordinated action to hold them accountable.”
The defendants are presumed innocent unless proven guilty.