Recent Posts in Medicare Fraud Category

In Washington, D.C., an Oakland, California woman was convicted of health care fraud in connection with a scheme to bill Medicare for power wheelchairs that were medically unnecessary, announced the Departments of Justice and Health and Human Services (HHS). After a one-week trial in federal court in Los Angeles, a jury found Donna K. Wells, guilty of one count of health care fraud. The evidence introduced at trial showed that Wells worked the streets and low-income, senior living communities of Oakland to recruit Medicare beneficiaries to bill Medicare for expensive power wheelchairs and other durable medical equipment (DME) which the beneficiaries did not want, need or use. The beneficiaries who testified at trial said that Wells approached them on the street, at the store, or in the lobby of their apartment buildings and offered them free power wheelchairs in exchange for the beneficiaries allowing Wells to copy their Medicare and California identification cards. One beneficiary testified that when she told Wells that she wanted a hospital bed and did not need or want a power wheelchair, Wells said that the beneficiary had to accept a power wheelchair in order to get a hospital bed. Based on that representation, the beneficiary agreed to accept both a power wheelchair and a hospital bed even though she did not need and never used the wheelchair.

Witnesses who lived in or worked at the San Pablo Hotel, one of the low-income senior living communities where Wells illegally recruited beneficiaries, testified that Wells often sat in the lobby of the hotel offering residents free power wheelchairs and copying their Medicare and California identification cards. These and other witnesses testified that many of the residents of the San Pablo Hotel did not use the power wheelchairs they received through Wells.

According to testimony at trial, Wells sold the beneficiaries' Medicare information to others. Witnesses testified that Wells charged them between $400 and $500 for the Medicare information of each beneficiary she recruited. One witness testified that over a four-year period, Wells sold the witness the Medicare information of approximately 200 different beneficiaries. Once these witnesses received the Medicare information from Wells, they sold the information to a fraudulent medical clinic in Los Angeles, which then used the information to fabricate fraudulent prescriptions for power wheelchairs and other DME in the names of the beneficiaries whom Wells recruited. One of the doctors whose name appeared on these fraudulent prescriptions testified that he never wrote the prescriptions or treated any of the Oakland beneficiaries whom Wells recruited.

Witnesses testified that they purchased the fraudulent power wheelchair and DME prescriptions from the fraudulent medical clinic, and then sold both the Medicare information they received from Wells and the fraudulent prescriptions for more than $1,000 per prescription to a number of Los Angeles-area DME supply companies. These DME supply companies used the beneficiaries' information and the fraudulent prescriptions to submit claims to Medicare for power wheelchairs which cost Medicare approximately $4,000 per wheelchair but cost the DME supply companies approximately $900 per wheelchair wholesale. Evidence introduced at trial showed that these DME supply companies submitted more than $577,000 in false power wheelchairs claims to Medicare. Several beneficiaries testified at trial that they did not need and rarely, if ever, used their power wheelchairs.

One of the DME supply companies that used the Medicare information from Wells was Maydads Medical Supply of Arleta, Calif. Trial evidence established that between June 2007 and August 2009, Maydads Medical Supply submitted approximately $470,973 in false and fraudulent claims to Medicare, almost all of which were for power wheelchairs. The owner and operator of Maydads Medical Supply, Sylvester Ijewere, pleaded guilty to health care fraud and was sentenced on Oct. 5, 2010, to 46 months in prison.

Wells was originally charged in October 2009 with three counts of health care fraud. The jury was unable to reach a verdict on two of the three counts. U.S. District Court Judge Dales S. Fischer scheduled Wells' sentencing for March 28, 2011. Wells faces a maximum penalty of 10 years in prison and a $250,000 fine.

The case was investigated by the California Department of Justice. HHS OIG assisted with the trial. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Central District of California. Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for more than $2 billion. In addition, HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Because a federal healthcare fraud crimes charge is a serious matter, you will need to consult a skilled and professional federal attorney who can take charge of the situation quickly. It is imperative you do not risk your freedom when you have the power of the federal government investigating your case. Criminal defense attorney's Donald Marks and Anthony Brooklier are strong and aggressive federal lawyers from Marks & Brooklier. We have four decades of experience in this field, serving hundreds of clients in Los Angeles County, San Fernando Valley and Beverly Hills area. We are confident we can assist you with your federal healthcare criminal charges. Contact a Los Angeles healthcare fraud criminal defense attorney today for a free consultation

Sylvester Ijewere, was also ordered to pay $211,755 in restitution by United States District Judge Dale S. Fischer of the Central District of California. In addition, Ijewere was ordered to serve three years of supervised release following his prison term.

Ijewere pleaded guilty on April 12, 2010, to health care fraud. Ijewere, the owner of Maydads Medical Supply, admitted that between June 2007 and October 2009, he conspired with others to purchase fraudulent prescriptions and medical documents which he used to submit false claims to Medicare for expensive, high-end power wheelchairs, and other DME. Ijewere received approximately $4,000 in reimbursement payments for each power wheelchair claim he submitted to Medicare. Approximately 50 percent of the Medicare beneficiaries to whom Ijewere claimed Maydads had supplied power wheelchairs and other equipment lived more than 100 miles from Maydads’ Los Angeles-area offices in Central and Northern California.

As a result of this scheme, Ijewere admitted that he submitted or caused the submission of approximately $471,345 in false and fraudulent claims to Medicare through Maydads. Ijewere’s co-conspirator, Donna Wells, a patient recruiter, was charged for her role in the scheme in October 2009, and is scheduled to begin trial on Nov. 9, 2010.

Sentencing was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney André Birotte Jr. for the Central District of California; Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse (CAL-DOJ); Glenn R. Ferry, Special Agent-in-Charge for the Los Angeles Region of the Office of Inspector General (OIG) for HHS (HHS-OIG); and Steven Martinez, Assistant Director in Charge of the FBI’s Los Angeles Field Office.

The case is being prosecuted by Trial Attorney Jonathan T. Baum of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Kerry C. O’Neill of the Central District of California. The case is being investigated by CAL-DOJ. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 810 individuals who collectively have falsely billed the Medicare program for more than $1.85 billion. In addition, HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Because a federal healthcare fraud crimes charge is a serious matter, you will need to consult an experienced and professional attorney who can take charge of the situation quickly. Penalties for federal fraud crime include sentences up to 30 years, in addition to fines and other penalties. It is imperative you do not risk your freedom when you have the power of the federal government investigating your case. Criminal defense attorney's Donald Marks and Anthony Brooklier are strong and aggressive lawyers from Marks & Brooklier. We have years of experience in this field, serving hundreds of clients in Los Angeles County, San Fernando Valley and Beverly Hills area. We are confident we can assist you with your federal fraud crime charges. Contact a Los Angeles healthcare fraud criminal defense lawyer today for a free consultation

The government alleges that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient observation basis or as emergency room visits.

“Our office will aggressively work with investigative partners to protect healthcare funds from fraud and abuse,” said Laura Duffy, United States Attorney for the Southern District of California. “Today’s settlement demonstrates our commitment to holding health care providers who receive federal funds and knowingly defraud or overcharge federal health care programs accountable.”

The allegations arise from a lawsuit that was brought under the qui tam, or whistleblower, provisions of the False Claims Act (FCA), which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery. The whistleblower in this case, Pietro Ingrande, a former employee of El Centro Regional Medical Center, will receive $375,000 as his share of the recovery.

The United States has agreed to dismiss the lawsuit as a result of the settlement. In addition, as a condition of continued participation in federal health care programs, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG-HHS) has required El Centro Regional Medical Center to enter into a Corporate Integrity Agreement. The agreement subjects the hospital to strict policies and procedures to ensure future compliance with applicable statutes and regulations that govern the use of federal health care funds.

“Whistleblowers are critical to ensuring that Medicare dollars are not siphoned off, but find their way to those who most need them,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the OIG-HHS. “Office of Inspector General special agents and our law enforcement partners have forged a powerful team that will work with private citizens who come forward to protect the Medicare Trust Fund and defend it from fraud and abuse.”

The investigation and settlement of this case are the result of the collaborative effort of the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Southern District of California, OIG-HHS, and the FBI. This settlement is part of the government’s emphasis on combating health care fraud and another step for the HEAT initiative, which was announced by Attorney General Holder and Secretary Sebelius in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation.

Fraud consists of many different types of crimes, but is generally defined as intentional misrepresentation or concealment of information in order to deceive or mislead. Fraud crimes use deception on unsuspecting individuals who fall for a scheme or sales pitch that sounds too good to be true. If you have been accused of a state or federal fraud crime, you will need an experienced Los Angeles fraud crimes defense attorney to represent you in defense against these charges. Depending on the manner in which the fraud was committed, a fraud crime may be charged on the state or federal level. Fraud criminal lawyers at the Los Angeles based law firm Marks and Brooklier handle defense for any number of fraud crime charges.

If you has been arrested for a federal fraud crime, you will need to consult a Los Angeles and United States federal fraud criminal defense lawyer who has the special knowledge of this area of the law. Attorneys Donald Marks and Anthony Brooklier are qualified Los Angeles criminal attorneys to represent you. Contact us for a free consultation, 24/7, strictly confidential.