Featured content from: American Health Lawyers Association
Published on: June 7, 2013
- A federal judge sentenced Alan Emmett Bradley, a certified alcohol and drug abuse counselor, to two years in prison and ordered him to pay $151,898.75 in restitution for defrauding Connecticut’s Medicaid program, Deirdre M. Daly, Acting U.S. Attorney for the District of Connecticut, announced in a press release. According to court documents and statements made in court, Bradley submitted claims to Medicaid indicating he performed 75 to 80-minute individual psychotherapy sessions when in fact “[h]undreds of these counseling sessions did not occur.” Bradley pleaded guilty in March to one count of healthcare fraud, the release said.
- U.S. Attorney Daly also announced June 3, along with other federal officials, the guilty plea of Gary F. Anusavice to healthcare fraud and tax evasion in connection with his role in a $20 million Medicaid fraud scheme involving three dental clinics that he operated in Connecticut despite being barred from participating in Medicaid and other federal healthcare programs. According to court documents and statements made in court, a press release said, Anusavice, who previously surrendered his dental license in Massachusetts and Rhode Island, has been excluded from Medicaid and federal healthcare programs since 2008. But from 2008 to April 2011, Anusavice owned and operated the dental clinics using a licensed dentist as the nominal head on the Medicaid enrollment form. According to the release, Anusavice “actively managed the dental clinics, recruited dentists and oversaw their hiring.” The release also noted a related settlement with the Connecticut Attorney General’s Office in which Anusavice agreed to pay the state $9.9 million, representing treble damages under the Connecticut False Claims Act and restitution under the Connecticut Unfair Trade Practices Act.
- Physician Eugene Goldman, MD was found guilty by a jury for violating the Anti-Kickback Statute while employed as the medical director at a Home Care Hospice Inc. where he referred Medicare or Medicaid patients, according to a June 3 press release issued by the U.S. Attorney's Office for the Eastern District of Pennsylvania. The release said the jury returned guilty verdicts against Goldman on one count of conspiring to violate the AKS and four counts of violating the AKS. According to the release, Goldman received roughly $263,000 illegal payments from HCH that were disguised as compensation for services performed as the hospice’s medical director, when in fact the payments were for the referral of Medicare and Medicaid patients to HCH.
- On remand from the Fifth Circuit, a federal judge ordered Drs. Arun and Kiran Sharma, a married couple, to pay nearly $37.7 million in restitution and forfeiture for defrauding Medicare, Medicaid, and more than a dozen private insurers, U.S. Attorney for the Southern District of Texas , Kenneth Magidson announced June 3 in a press release. The judge previously sentenced Arun to 10 years and Kiran to eight years in prison and ordered them to pay over $40 million in restitution. On appeal, the Fifth Circuit vacated and remanded for relculation of the restitution amount finding the lower court erred in calculating the loss amount. The Sharmas, who operated pain management clinics, previously pled guilty to defrauding healthcare insurers by billing for pain injections they never administered. United States v. Sharma, Nos. 11-20102, 11-20167, 11-20204 (5th Cir. Dec. 20, 2012).
- U.S. Attorney Sarah R. Saldaña of the Northern District of Texas announced in a May 31 press release that Dallas County Hospital District d/b/a Parkland Health and Hospital System (Parkland) agreed to pay $1.4 million to resolve allegations it violated the federal and Texas false claims acts by submitting, or causing the submission of, improper physical medicine and rehabilitation (PMR) claims between 2007 and 2011. The press release noted Parkland fully cooperated with the investigation and admitted no wrongdoing or liability in agreeing to the settlement. According to the allegations, the claims involved “(1) consultations that were never requested by a patient’s treating physicians and/or lacked medical necessity; (2) services related to the inappropriate supervision of residents and/or lacked medical necessity; (3) up-coded and inflated evaluation and management services; (4) inpatient rehabilitation stays that did not meet billing requirements; and (5) other unreimbursable costs.” The settlement resolves the qui tam action brought by Lien Kyri, M.D., a former resident in the PM&R department, UTSW Medical Center at Dallas, the release said. Parkland also entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General (OIG).
- A jury convicted Woody Medlock and his wife Kathy Medlock, who formerly owned Murfreesboro Ambulance Service, on various charges in connection with a scheme to submit fraudulent claims to Medicare and Medicaid totaling more than $1.6 million for reimbursement of ambulance transports of patients to and from dialysis treatments, announced Acting U.S. Attorney for the Middle District of Tennessee David Rivera in a May 31 press release. Evidence and testimony at trial indicated these patients were not eligible for ambulance transportation, the release said. A third defendant, Woody (“Bubba”) Medlock, Jr., was acquitted of similar charges, the release said.
- A federal judge sentenced May 29 Alegria Phankonsy to 51 months in prison and criminal forfeiture of $11.1 million in assets after she pleaded guilty in November 2012 to charges stemming from a fraudulent medical equipment billing scheme, U.S. Attorney for the District of Nevada Daniel G. Bogden announced. According to the indictment, Phankonsy operated several companies that billed Medicare for medical equipment such as leg prostheses and power wheelchairs that were not ordered by physicians, were not medically necessary, or were not provided at all. Phankonsy used “marketers” to obtain patient Medicare information that was used to submit the fraudulent bills, the release said.