{"id":24645,"date":"2016-06-22T13:58:01","date_gmt":"2016-06-22T20:58:01","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=24645"},"modified":"2016-06-22T13:58:01","modified_gmt":"2016-06-22T20:58:01","slug":"13-suspects-including-five-doctors-charged-health-care-fraud-involving-161-million","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=24645","title":{"rendered":"22 Defendants, Including Five Doctors, Charged with Health Care Fraud Involving $161 Million in 13 Criminal Cases"},"content":{"rendered":"

\"fraud-medicare-card-cube\"LOS ANGELES<\/strong><\/span><\/p>\n

\n

Federal authorities brought 13 criminal cases against 22 defendants involving health care fraud schemes, officials announced Wednesday.<\/span><\/p>\n

Several medical professionals were charged as part of the sweep, including five physicians, a psychiatrist, one pharmacist and an occupational therapist.<\/span><\/p>\n

Most of the 22 defendants named in the cases were arrested on Monday and Tuesday. Several defendants self-surrendered after learning of the federal charges. A separate announcement details all 13 cases and the defendants charged in those cases.<\/span><\/p>\n

The cases announced today allege various schemes that led to more than $161 million in fraudulent bills being submitted to publicly funded health care programs such as Medicare and TRICARE, officials said.<\/span><\/p>\n

TRICARE, the military\u2019s managed care program, was the primary victim of schemes involving the compounding pharmacies.<\/span><\/p>\n

\u201cPatients were pawns in an alleged pay-for-play fraud scheme,\u201d said California Insurance Commissioner Dave Jones<\/strong>. \u201cPatients should be able to trust that medications prescribed for them are based on their healthcare needs, not on payoffs and kickbacks to physicians and pharmacists.\u201d<\/span><\/p>\n

The cases filed in federal court in Los Angeles and Santa Ana are part of a nationwide sweep announced today in Washington by Attorney General Loretta Lynch.<\/strong><\/span><\/p>\n

She said criminal and civil charges have been filed against 301 individuals who allegedly participated in health care fraud schemes involving approximately $900 million in false billings.<\/span><\/p>\n

The local cases were filed by Assistant United States Attorneys and Trial Attorneys with the Justice Department\u2019s Medicare Fraud Strike Force.<\/span><\/p>\n

\n

\"Department\u201cHealth care fraud is a serious offense that costs Americans billions of dollars, and the cases announced today here in Los Angeles alone cost taxpayers more than $100 million,\u201d said U.S. Attorney Eileen M. Decker. <\/span><\/p>\n

The cases filed in the Southland involve actual losses of more than $125 million, with the bulk of those losses associated with five cases related to schemes involving compounding pharmacies.<\/span><\/p>\n<\/blockquote>\n

In schemes orchestrated by marketers (sometimes called \u201ccappers\u201d), compounding pharmacies were provided with large numbers of prescriptions, generally for pain medications, that carried huge reimbursements, often more than $15,000 for each prescription.<\/span><\/p>\n

The prescriptions were written by doctors who received kickbacks from marketers or from \u201ctelemedicine\u201d websites that had little or no contact with patients.<\/span><\/p>\n

The prescriptions were written for \u201cpatients\u201d who, in many cases, did not want the prescriptions, had never met the prescribing doctors or had no idea why they were receiving the medications. In many cases, the beneficiary information was being used without the knowledge of the \u201cpatients\u201d until the prescriptions showed up at their homes.<\/span><\/p>\n

Over the course of just a few years, TRICARE paid hundreds of millions of dollars for medications dispensed to \u201cpatients\u201d across the nation, typically creams that supposedly would treat minor pain, scars, erectile dysfunction or \u201cgeneral wellness.\u201d<\/span><\/p>\n

Five of the cases announced today relate to compounding pharmacies and allege losses of more than $100 million, most of which was paid by TRICARE over the course of just a few months.<\/span><\/p>\n

In one case, John Garbino, a marketer who resides in Dana Point, was charged with receiving illegal kickbacks after referring prescriptions to compounding pharmacies that filled the prescriptions and billed TRICARE.<\/span><\/p>\n

One Palmdale pharmacy allegedly received more than $46 million from TRICARE in only six months. Another pharmacy in Corona received nearly $6 million over the same six-month period. Garbino allegedly received illegal kickbacks of as much as 65 percent for referring prescriptions to the compounding pharmacies.<\/span><\/p>\n

The criminal complaint against Garbino alleges that one of the pharmacies dramatically increased its claims to TRICARE \u201cfor filling compounded medications prescriptions that had been specially formulated to achieve the highest possible reimbursement rates rather than the greatest medical efficacy.\u201d<\/span><\/p>\n

In another scheme, the Florida-based operator of a \u201ctelemedicine\u201d website was charged with health care fraud for allegedly misusing the identity and medical credentials of a physician to submit prescriptions to a compounding pharmacy. <\/span><\/p>\n

The criminal complaint in this case alleges that two local pharmacies received more than $6.5 million in payments from TRICARE in 2015.<\/span><\/p>\n

In a third case, the owner of a La Mirada pharmacy, two marketers and a doctor were indicted on charges of paying and receiving illegal kickbacks. Health insurers paid the pharmacy, Valley View Drugs, more than $20 million, and the pharmacy paid nearly half of that to companies associated with the marketers.<\/span><\/p>\n

In other cases announced today, a doctor who had offices in Temecula and Mira Loma allegedly submitted nearly $12 million in fraudulent bills to Medicare for unnecessary \u201cvein ablation\u201d surgery, according to officials.<\/span><\/p>\n

Another doctor was charged for helping the owner of a Granada Hills medical clinic, who recruited Medicare patients with promises of free equipment and used their beneficiary information to bill for services that simply were never provided.<\/span><\/p>\n

\u201cMedical professionals who seek to enrich themselves through Medicare fraud \u2013 such as exchanging illegal kickbacks or billing for medically unnecessary procedures \u2013 undermine this taxpayer-funded program and drive up health care costs for everyone,\u201d said Special Agent in Charge Chris Schrank, of the U.S. Department of Health and Human Services, Office of Inspector General. <\/span><\/p>\n

Another case announced today charges three defendants in a scheme to defraud the health benefit plans established for members of the International Longshore and Warehouse Union and Federal Express employees.<\/span><\/p>\n

Participants in the scheme allegedly paid beneficiaries of those plans to undergo unnecessary sleep and nerve conduction velocity studies that were then billed to the plans. The defendants operated facilities in Sherman Oaks and San Pedro, where the testing was conducted as part of the fraud scheme that submitted at least $16 million in bills to the union and FedEx health plans. The defendants in this case also face money laundering charges.<\/span><\/p>\n

\u201cThose who commit fraud targeting health care funding get rich on the backs of American taxpayers who watch their premiums go up,\u201d said Deirdre Fike, Assistant Director in Charge of the FBI\u2019s Los Angeles Field Office. \u201cAnyone who identifies suspicious billing practices or unlawful activity by a provider should contact a member of the Strike Force.\u201d<\/span><\/p>\n

\u201cIn the coming years, we will continue to leverage our financial skill set and focus on investigating those whose criminal activity drives up medical costs and jeopardizes a system that our citizens have come to trust,\u201d stated IRS Criminal Investigation\u2019s Acting Special Agent in Charge Anthony J. Orlando. \u201cWe will continue to work with our federal and state law enforcement partners to bring to justice those individuals who prey on the nation’s health care system for their own personal greed.\u201d<\/span><\/p>\n

Indictments and criminal informations contain allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Federal authorities brought 13 criminal cases against 22 defendants involving health care fraud schemes, officials announced Wednesday.
\nSeveral medical professionals were charged as part of the sweep, including five physicians, a psychiatrist, one pharmacist and an occupational therapist.<\/p>\n","protected":false},"author":1,"featured_media":6172,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,3],"tags":[44,2785],"class_list":["post-24645","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-home-main-slider","category-u-s-department-of-justice","tag-medicare-fraud","tag-tricare"],"yoast_head":"\n22 Defendants, Including Five Doctors, Charged with Health Care Fraud Involving $161 Million in 13 Criminal Cases<\/title>\n<meta name=\"description\" content=\"Federal authorities brought 13 criminal cases against 22 defendants involving health care fraud schemes, officials announced Wednesday. 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