Authorities Charge 90 with Medicare Fraud

   WASHINGTON - (FBI) - 5/14/2014 - Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced on May 13 that a nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings.
   Holder and Sebelius were joined in the announcement by Acting Assistant Attorney General David O’Neil of the Justice Department’s Criminal Division, FBI Assistant Director Joseph Campbell, U.S. Department of Health and Human Services (HHS) Inspector General Daniel Levinson, and Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity Shantanu Agrawal.
   The coordinated takedown was the seventh national Medicare fraud takedown in Strike Force history. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
   Since their inception in March 2007, strike force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion. In addition, CMS, working in conjunction with HHS-OIG, has suspended enrollments of high-risk providers in five strike force locations and has removed over 17,000 providers from the Medicare program since 2011.
   The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Almost 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other federal, state, and local law enforcement agencies participated in the takedown.
   “Medicare is a sacred compact with our nation’s seniors, and to protect it, we must remain aggressive in combating fraud,” Holder said. “This nationwide Medicare Strike Force takedown represents another important step forward in our ongoing fight to safeguard taxpayer resources and to ensure the integrity of essential health care programs. Department of Justice will not tolerate these activities. And we will continue working alongside the Department of Health and Human Services—as well as federal, state, and local partners—to use every appropriate tool and available resource to find, stop, and punish those who seek to take advantage of their fellow citizens.”
   The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and pharmacy fraud.
   According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of conspiring to submit approximately $260 million in fraudulent billings.
  “Today, across the nation, scores of defendants were arrested for engaging in hundreds of millions of dollars in health care fraud,” O’Neil said. “Among the defendants charged were 27 medical professionals, including 16 doctors. The crimes charged represent the face of health care fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients. The fraud was rampant, it was brazen, and it permeated every part of the Medicare system. But law enforcement continues to strike back. Using cutting-edge, data-driven investigative techniques, we are bringing fraudsters to justice and saving the American taxpayers billions of dollars. Overall, since its inception, the Department of Justice’s Medicare Fraud Strike Force has charged nearly 1,900 individuals involved in approximately $6 billion of fraud. We are committed to using every tool at our disposal to prevent, deter, and prosecute health care fraud.”
   In Miami, a total of 50 defendants were charged for their alleged participation in various fraud schemes involving approximately $65.5 million in false billings for home health care and mental health services and pharmacy fraud. In one case, two defendants were charged in connection with a $23 million pharmacy kickback and laundering scheme. Court documents allege that the defendants solicited kickbacks from a pharmacy owner for Medicare beneficiary information, which was used to bill for drugs that were never dispensed. The kickbacks were concealed as bi-weekly payments under a sham services contract and were laundered through shell entities owned by the defendants.
   Eleven individuals were charged by the Houston Medicare Strike Force. Five Houston-area physicians were charged with conspiring to bill Medicare for medically unnecessary home health services. According to court documents, the defendant doctors were paid by two co-conspirators to sign off on home health care services that were not necessary and often never provided.
   Eight defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of approximately $32 million. In one case, a doctor was charged for causing almost $24 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment, including over 1,000 expensive power wheelchairs and home health services that were not medically necessary and frequently not provided.
   In Detroit, seven defendants were charged for their roles in fraud schemes involving approximately $30 million in false claims for medically unnecessary services, including home health services, psychotherapy, and infusion therapy. In one case, four individuals, including a doctor, were charged in a sophisticated $28 million fraud scheme in which the physician billed for expensive tests, physical therapy, and injections that were not necessary and not provided. Court documents allege that when the physician’s billings raised red flags, he was put on payment review by Medicare. He was allegedly able to continue his scheme and evade detection by continuing to bill using the billing information of other Medicare providers, sometimes without their knowledge.
   In Tampa, Florida, seven individuals were charged in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions of dollars in physician services and tests that never occurred. In one case, five individuals were charged for their alleged roles in a $12 million health care fraud and money laundering scheme that involved billing Medicare using names of beneficiaries from Miami-Dade County for services purportedly provided in Tampa area clinics, 280 miles away. The defendants then allegedly laundered the proceeds through a number of transactions involving several shell entities.
   In Brooklyn, New York, the strike force announced an indictment against Syed Imran Ahmed, M.D., in connection with his alleged $85 million scheme involving billings for surgeries that never occurred; Dr. Ahmed had been arrested last month and charged by complaint. Dr. Ahmed has charged with health care fraud and making false statements. In addition, the Brooklyn Strike Force charged six other individuals, including a physician and two billers who allegedly concocted a $14.4 million scheme in which they recruited elderly Medicare beneficiaries and billed Medicare for medically unnecessary vitamin infusions, diagnostic tests and physical and occupational therapy supposedly provided to these patients.
   The cases are being prosecuted and investigated by Medicare Fraud Strike Force teams composed of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana, the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.
   Source: U.S. Federal Bureau of Investigation

Justice Department Clemency Criteria Praised

   WASHINGTON, D.C. -- (ACLU) - 4/23/2014 - Deputy Attorney General James Cole announced on April 23 a new set of criteria the Justice Department and White House will use when considering clemency petitions from federal prisoners. The new criteria will help the Justice Department identify federal prisoners who, if sentenced under current sentencing laws and policies, would likely have received a substantially lower sentence.
   "Our federal sentencing laws have shattered families and wasted millions of dollars," said Vanita Gupta, ACLU deputy legal director. "Too many people—particularly people of color—have been locked up for far too long for nonviolent offenses. The President now has a momentous opportunity to correct these injustices in individual cases.
   If we're ever going to see truly systemic and smart reform of the federal criminal justice, however, we need Congress to step up and pass the Smarter Sentencing Act."​
   Clemency Project 2014, a working group composed of the Federal Defenders, the American Civil Liberties Union, Families Against Mandatory Minimums, the American Bar Association, and National Association of Criminal Defense Lawyers, as well as individuals active within those organizations, wholeheartedly supports Cole’s announcement and the Justice Department's plans to restore the integrity of the clemency process.
   "The doors of the Office of the Pardon Attorney have been closed to petitioners for too long. This announcement signals a truly welcome change; the culture of "no" that has dominated that office is being transformed," said Mary Price, FAMM General Counsel. "We stand ready to assist in any way we can to support petitioners and bring their cases to the attention of the President."  
   Clemency Project 2014 launched in January after Deputy Attorney General James Cole asked the legal profession to provide pro bono assistance to federal prisoners who would likely have received a shorter sentenced if they'd been sentenced today.
   "Clemency Project 2014 marks the beginning of the end of the age of mass incarceration. We must seize this historic opportunity to start the process of remedying decades of cruel and unnecessarily harsh sentencing policies. I call upon the nation’s lawyers, especially the criminal defense bar, to rise to this challenge in an unprecedented effort to restore hope and the prospect of an early return to freedom for the countless deserving individuals who are languishing in federal custody.," NACDL President Jerry Cox said.
   Clemency Project members will collaborate to recruit and train attorneys on how to screen for prisoners who meet the criteria laid out by the deputy attorney general. Pursuant to the criteria announced today, candidates eligible for clemency must be:

• serving a federal sentence;
• serving a sentence that, if imposed today, would be substantially shorter;
• have a non-violent history with no significant ties to organized crime, gangs or cartels;
• have served at least 10 years;
• have no significant prior convictions;
• and have demonstrated good conduct.

   "Federal defenders have advocated for reform of the criminal justice system for many years, and we wholeheartedly endorse the President's commitment to lowering the sentences of prisoners who are serving unduly harsh sentences through the clemency process," said Michael Nachmanoff, Federal Public Defender for the Eastern District of Virginia. "In recent years, federal defenders have assisted thousands of defendants to reunite with their families through the crack retroactivity process, and we are eager to work with the other organizations affiliated with the Clemency Project 2014 to help many others serving unfair sentences that would not be imposed today."
   While Clemency Project 2014 will focus on those cases that clearly fit the broad criteria described by Deputy Attorney General Cole, the groups stress that there are many other federal prisoners whose sentences are grossly disproportionate to the crimes for which they were convicted. The groups will continue to urge the Department of Justice and President Obama to vastly expand use of the clemency power to correct widespread injustice. Similarly, each organization participating in the Project supports legislative action to curtail sentencing laws that continue to cause unjust sentences.
   Clemency Project 2014 looks forward to support and participation from other legal and community advocacy groups, and gratefully recognizes the early support of the National Action Network, the Lawyers Committee for Civil Rights and the National Asian Pacific American Bar Association, as well as state bar associations, including the New York State Bar Association, before which Deputy Attorney General Cole first announced this initiative last January.
   Lawyers interested in volunteering for the project may do so by writing to clemencyproject@nacdl.org