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Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme

Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme.

Two owners of Guam Medical Transport (GMT) were sentenced to prison terms today for their roles in a health care fraud and money laundering scheme that resulted in a loss to the United States of approximately $ 10.8 million, one of the largest single Medicare ambulance fraud cases ever prosecuted by the Justice Department.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Shawn N. Anderson of the Districts of Guam and the Northern Mariana Islands, Special Agent in Charge Eli S. Miranda of the FBI’s Honolulu Field Office, Special Agent in Charge Justin Campbell of IRS Criminal Investigation (IRS-CI) Seattle Field Office and Special Agent in Charge Timothy DeFrancesca of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) Los Angeles Regional Office made the announcement.

According to their admissions at the plea hearing, from approximately March 11, 2010, to approximately March 21, 2014, the defendants engaged in a conspiracy to defraud Medicare and TRICARE by submitting claims for reimbursement for medically unnecessary ambulance services that GMT provided to patients with ESRD.

As part of the scheme, the defendants directed GMT employees to remove from internal documents references to GMT patients’ ability to walk because they knew that Medicare and TRICARE would not provide reimbursement for the patients.

The post Guam Ambulance Company Owners Sentenced to Prison for Their Roles in Medicare Ambulance Fraud Scheme appeared first on The Coding Network.

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Florida Exec Sentenced to 20 Years in $1 Billion Healthcare Fraud Case

Former owner of a chain of skilled nursing and assisted living facilities in South Florida faces a 20-year sentence after being found guilty of a decades-long scam of paying bribes and receiving kickbacks in a massive billion-dollar Medicare fraud and money laundering scheme. This extensive healthcare fraud conspiracy resulted in hundreds of millions of dollars […]

The post Florida Exec Sentenced to 20 Years in $ 1 Billion Healthcare Fraud Case appeared first on AAPC Knowledge Center.

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Gate City Transportation Sentenced For Health Care Fraud For Over $5 Million

A Greensboro-based medical transport company was sentenced in court for health care fraud after pleading guilty to one count of health care fraud in October 2018, according to US Attorney lawyer Matthew G.T. Martin of the District of North Carolina. The company in question, Gate City Transportation, was ordered to pay a $ 100 fine, a $ 400 penalty tax, and restitution over five million. The funds would go, in their entirety, to the N.C. Fund for Medical Assistance. The verdict and penalty was handed down by US District Court Judge Loretta “Copeland” Biggs of the District of North Carolina.

Full The Full Story Her!

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Doctor Sentenced to Prison for Health Care Fraud

In court in Central Islip, Hal Abrahamson, a foot doctor with offices in Plainview, Long Island, and Rego Park, Queens, was sentenced by US District judge Denis R. Hurley to at least one year and a day in jail for his role during a health care fraud scheme. The Court additionally ordered Abrahamson to pay restitution of $ 869,651, a $ 50,000 fine and forfeit $ 177,000. On June 26, 2018, Abrahamson pleaded guilty to health care fraud in reference to the operation of his medical specialty practice.

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Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

A LA, California-based dental practitioner was sentenced to forty months in jail last week for his role during a $ 3.8 million health care fraud scheme during which he charged various dental insurance carriers for crowns and fillings that were not ever actually provided to patients. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. attorney Nicola T. Hanna of the Central District of CA, Acting Assistant Director responsible for John P. Selleck of the FBI’s Washington, D.C. Field workplace and Assistant Director accountable for Paul D. Delacourt of the FBI’s LA Field workplace generated the announcement.

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Baton Rouge Physician sentenced to over three years in jail in a fraud scheme

A former owner and medical director of a Baton Rouge pain management clinic was sentenced to over 3 years in federal jail Friday during a health care fraud scheme, federal authorities mentioned. Dr. John Eastham Clark, who co-owned Louisiana Spine & Sports on Bluebonnet avenue, additionally was ordered to pay nearly $ 255,000 in restitution by Chief U.S. District judge Shelly Dick.

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Tennessee Podiatrist Sentenced For Health Care Fraud Scheme

Dr. John J. Cauthon, 51, of Murfreesboro, Tennessee, was sentenced yesterday in U.S. District Court to two years in prison for healthcare fraud, announced Don Cochran, U.S. Attorney for the Middle District of Tennessee.  Cauthon was indicted in October 2015 on seven counts of healthcare fraud and was found guilty on four counts, after a jury trial in September 2017.

In sentencing Cauthon, Chief U.S. District Judge Waverly D. Crenshaw, Jr., noted that Cauthon had accepted no responsibility for his actions and showed no remorse.  Chief Judge Crenshaw found that Cauthon caused an intended loss of $ 218,000, and ordered restitution of approximately $ 83,252.63.

Cauthon is a podiatrist in Murfreesboro who contracted to provide podiatric services to residents of nursing homes located throughout Tennessee.

According to court documents, between May 2014 and August 2015, Cauthon engaged in a scheme to defraud Medicare, TennCare, and BlueCross BlueShield of Tennessee, by submitting $ 200,000 in fraudulent claims for a surgical procedure for nail avulsions, which he did not perform.

At trial, numerous witnesses from nursing homes across the state of Tennessee testified that Cauthon never performed the avulsion procedures that he claimed he performed; including in some instances, claiming that he had performed more than 30 avulsions in a single day.  Nursing home residents also testified that Cauthon simply clipped their toenails.  Former employees also testified that Cauthon directed them to bill Medicare for services that were medically unnecessary and directed them to fit bed-ridden patients in nursing homes with ankle braces, which served no medical purpose.

This case was investigated by the Tennessee Bureau of Investigation; the U.S. Department of Health and Human Services – Office of Inspector General; and the United States Attorney’s Office for the Middle District of Tennessee.  Assistant U.S. Attorneys Henry Leventis and Ryan Raybould prosecuted the case.

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New York Doctor Sentenced To 13 Years In Prison For Multi-million Dollar Health Care Fraud

A New York surgeon who practiced at hospitals in Brooklyn and Long Island was sentenced today to 156  months in prison for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Richard P. Donoghue of the Eastern District of New York, Assistant Director in Charge William F. Sweeney Jr. of the FBI’s New York Field Office and Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations made the announcement.

Syed Imran Ahmed M.D., 51, of Glen Head, New York, was sentenced by U.S. District Judge Dora L. Irizarry of the Eastern District of New York, who also ordered Ahmed to pay $ 7,266,008.95 in restitution, to forfeit $ 7,266,008.95, and to pay a $ 20,000 fine.  Ahmed was convicted in July 2016 after an 11-day trial of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering.

“Medicare is a crucial program for many of the most vulnerable people in our society – American seniors and those with disabilities,” said Acting Assistant Attorney General Cronan.  “In this case, Syed Ahmed put his own greed ahead of the trust we put in our medical professionals, draining over $ 7 million in precious funding from our Medicare program.  His conviction and the sentence imposed in this case demonstrate the Department of Justice’s unwavering commitment to protecting public funds and the integrity of our health care system.”

“Dr. Syed Ahmed treated Medicare like a personal piggy bank, stealing over $ 7.2 million by making fraudulent claims for medical procedures he never performed,” stated U.S. Attorney Donoghue.  “Dr. Ahmed will now pay the price for violating the trust that Medicare places in doctors.  His 13-year prison sentence and the heavy payments imposed should send a powerful message of deterrence to other medical professionals who would seek to defraud vital taxpayer-funded programs like Medicare for personal enrichment.  This Office, together with our law enforcement partners, will remain vigilant in rooting out health care fraud.”

“Health care fraud is often billed as a victimless crime, but that couldn’t be further from the truth,” said Assistant Director in Charge Sweeney.  “Someone is always left to foot the bill. Insurers, the insured, and others are the ones who pay the price. Those who employ these schemes will most certainly be brought to justice, as we’ve proven here today.”

“The fraud scheme that Dr. Ahmed engaged in was motivated by pure greed,” said Special Agent in Charge Lampert.  “HHS OIG and our law enforcement partners will continue to aggressively pursue all those who seek to unlawfully enrich themselves by victimizing participants of the Medicare program.”

According to evidence presented at trial, Ahmed, a surgeon who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform.  Ahmed wrote out lists of phony surgeries and sent the lists to his billing company in Michigan with instructions that they be billed to Medicare.  Ahmed also directed that the surgeries be billed as though they had taken place in an operating room so as to increase the payout for the fraudulent scheme, the evidence showed.

The evidence introduced at trial showed that Medicare paid over $ 7 million to Ahmed for fraudulent claims.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York.  Trial Attorney Debra Jaroslawicz of the Fraud Section, Assistant U.S. Attorney F. Turner Buford, formerly a Fraud Section trial attorney, and Senior Litigation Counsel Patricia Notopoulos of the Eastern District of New York are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $ 12.5 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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Charleston dentist sentenced to five years in federal prison for health care fraud

A Charleston dentist who falsely billed West Virginia Medicaid for more than $ 700,000 was sentenced today to 5 years in federal prison. Skaff, a dentist, admitted that he falsely inflated his billings (a practice commonly known as upcoding) by falsely claiming reimbursement for procedures involving impacted teeth (typically, only wisdom teeth are impacted). However, Skaff upcoded billings for tooth extractions by falsely informing Medicaid that he performed more complex procedures, such as extractions of impacted teeth, when he had actually performed simple procedures. Because Skaff upcoded these extractions, Medicaid paid $ 172 per tooth, much more than for a simple extraction.

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