Monday, December 30, 2013

Boyfriend Charged in Pregnant Teen's Killing

The suburban Chicago boyfriend of a pregnant teenager fatally shot on Christmas Day and his brother were denied bail Sunday and will remain in jail after being charged with first-degree murder in the death.
Eva Casara, whose baby survived and remains hospitalized, wasn't an intended target when an apparent robbery spiraled out of control, the Chicago Sun-Times ( http://bit.ly/KeoXnB ) reported.
Charged are her boyfriend, Anthony Lee, 16, and his brother, Diante Lamont Coakley, 21, both from Dolton, a suburb south of Chicago. It wasn't immediately clear if either Lee or Coakley had lawyers.
The 17-year-old Casara was "just in the wrong place at the wrong time with the wrong company," Dolton Police Chief John Franklin told the Sun-Times on Saturday. Franklin said it appeared to be part of a drug deal or robbery gone wrong.
A message left with Franklin by The Associated Press was not immediately returned. It wasn't immediately clear whether Lee would be tried as an adult.
On Sunday, Assistant State's Attorney Christina Kye offered more detail, saying that Lee, Coakley and a third brother headed out to rob someone — and Casara went along. At some point, Casara ended up in the car of the robbery target — and shots were fired at the car as it sped off, Kye said.
Kye said the intended robbery victim only understood Casara was in the car when he heard gurgling sounds behind him, then pulled over and left her. A passerby later came across Casara's body, she said.
Casara, who was 5 1/2 months pregnant, was pronounced dead early on Thursday — several hours after the Wednesday shooting. But doctors were able to save the Calumet City teen's baby.
While Casara was not the intended target in the shooting, the police chief stopped short of calling her death an accident.
"It's hard to call it an accident when you're firing a gun in the direction of people," he said.
Casara's aunt, Melody Vargas, told the Sun-Times, "She was just a victim of their stupidity, and they need to pay for it."

Suspect in 3 Colorado Slayings Captured in Okla.

A month long hunt for a man accused of killing three people in Colorado and then setting a house on fire to cover it up has ended with his capture in Oklahoma.
Harry Carl Mapps, 59, was arrested at a motel in Roland, Okla., on Saturday night, authorities said Sunday.
Mapps faces charges of first-degree murder and arson in the shooting deaths of Kim and Reggie Tuttle and their adult daughter, Dawn Roderick. Their bodies were found in the Tuttles' home in the southern Colorado town of Rye after it was damaged by fire on Nov. 27.
A booking photo showed Mapps with a swollen lip and large red patch on his right cheek, but authorities said there had been no struggle during his capture. No other details of his arrest were released.
Pueblo County, Colo., Sheriff Kirk Taylor said Mapps was found using information developed by the U.S. Marshals Service in Colorado, Oklahoma and Texas. Mapps had lived in Texas.
The Marshals Service had issued a fugitive warrant for Mapps and said authorities were searching for him nationwide.
It wasn't immediately clear if Mapps had an attorney, and authorities did not yet know if he would fight extradition to Colorado.
The fire at the Tuttles' house was ruled arson, and Taylor said it was meant to cover up the shootings.
Three days after the fire, deputies said Mapps was their primary suspect. Authorities said he had been living with the Tuttles and was working for a trucking company owned by Reggie Tuttle, 51.
Taylor said money appeared to be the motive for the shootings. Authorities claimed Mapps stole checks made out to one of the victims and cashed them on the day of the fire. He also faces theft, identity theft and forgery charges.
Pueblo County sheriff's investigators arrived in Oklahoma Sunday and hoped to speak to Mapps, said Lisa Shorter, the sheriff's spokeswoman.
Mapps wasn't armed when he was arrested, but investigators did not yet know whether there were any weapons in the motel room or Mapps' vehicle, said Charles Ahmad of the Marshals Service in Denver.
Ahmad said the firearm used to shoot the Tuttles and Roderick had not been recovered, and investigators believed Mapps still had it. Ahmad declined to identify the weapon.
Shorter and Ahmad said they did not yet know where Mapps had been while he was a fugitive. He once worked as a long-distance trucker, and authorities had said he was familiar with little-used back roads.
Friends called the Tuttles generous and caring.
"Kim and Reggie would help anyone who needed it," Winnie Owens, a friend and neighbor, told the Pueblo Chieftain. "The hearts of everyone in this valley go out to that family."
Kim Tuttle, 55, worked on the culinary staff at Parkview Medical Center in Pueblo.
Roderick, 33, lived in nearby Pueblo and had a husband and three children. Authorities haven't said why she was at her parents' home.
———

Time Running Short for Teen Declared Brain Dead

Without further court order, a California hospital could unhook a 13-year-old girl declared brain dead from a breathing machine.
Alameda County Superior Court Judge Evelio Grillo's current order allows Children's Hospital of Oakland to remove Jahi McMath from a ventilator at 5 p.m. Monday.
The family was pinning its hopes on a New York facility to care for the child after two California care homes withdrew offers to accept her.
Jahi underwent a tonsillectomy at the hospital on Dec. 9 to treat sleep apnea. After she awoke from the operation, her family said, she started bleeding heavily and went into cardiac arrest.
Doctors at Children's Hospital and an independent pediatric neurologist from Stanford University have concluded the girl is brain dead.
The hospital wants to remove her from life support, but the family said they believe she is still alive.
Chris Dolan, the family's attorney, said he was waiting to hear from the New York hospital after its facility director and medical director speak.
"The family is together, and today everybody is praying and being together," Dolan told the Associated Press Sunday. He said no decisions had been made about legal options for Monday, and would not comment on progress with the New York facility.
On Sunday, the hospital said it had not heard from the New York, or any other, facility about a transfer.
"We need to be able to talk to the other facility to understand what it is they are capable of doing," Cynthia Chiarappa, a hospital spokeswoman, said. "This is not transferring an individual in a vegetative state, but a dead body."
The hospital also said it would need to confirm there is "lawful transportation" included in any plan to transfer Jahi, and written permission from the coroner.
Dolan said previously that the family views the New York site as it's "last, last hope." He has also has said it was possible the family could ask Grillo for more time, or file a federal appeal.

Wednesday, December 25, 2013

Alcoholism Treatment is an Option

There has always been much confusion about alcoholism treatment. One of the most common questions that alcoholics are asking is: Does alcoholism treatment work?

Throughout the history of the world, there are documented cases of alcohol use and, in many instances, documented cases of sheer abuse, which can easily be transported back to modern times and in our daily lives right now.

Alcohol - A Force That Does NOT Play Favorites!

While alcohol can be a pleasant social stimulant, it can also be a hideous and destructive force that does not play favorites. So, if this drug has been causing so much havoc over such a long period in our history, why are we still using it? In true fashion, human beings are an interesting mixture of self-preservation and self-destruction, dosed with a healthy amount of denial when necessary, which means that when it comes to alcohol - we just don't get it.

While it is, of course, true that not every person who drinks is an alcoholic, it is also true that there has never been a true medical or other type of legitimate reason for "needing" a drink- except to feel more "mellow and relaxed" or to "escape" and, in fact, alcohol has gained huge approval socially - which has seriously removed its taboo factor. Having said this, alcohol seems to be here to stay and it is up to all of us to deal with this fact AND the fallout that is associated with having booze so readily available to everyone.

The CDC estimates that currently 50% of adults in the US are regular drinkers with 14% of adults being infrequent drinkers - this means that 64% of the population has at least 1 drink per year and while the CDC does not offer statistics on the number of alcoholics, it would appear that approximately 10% of adults in the US are alcoholics.

Suffering Pain Through Alcoholism

While to some, these may simply be numbers, to others, these numbers actually have faces and names - they are mothers and fathers, husbands and wives, sons and daughters and sisters and brothers. Being an alcoholic is not a solitary affair - not only do you hurt yourself, but you also hurt everyone around you who loves you. So, really, that number of 10% should be multiplied to reflect the true pain alcoholism causes families and loved ones.

Unfortunately, alcoholism cannot be cured, however, alcoholism treatment is possible and for many, that option is scarier than having that next drink. Indeed, recovery and alcoholism treatment from alcohol addiction, or any type of addiction, requires courage and a strong, strong support system. People in treatment are very, very brave because to them, living without their drug of choice now has to face all the pain and fear that drove them to drink in the first place - but it is very possible!

Treatment Is Truly An Option

Thankfully, there are many alcoholism treatment options available which have proven to arrest the disease. If you or someone you know is struggling with alcohol, you are encouraged to get help - for them and for yourself. All of these options for alcoholism treatment is confidential and/or anonymous. Remember that many people have been where you are and have survived to tell about it. Never despair.

Tuesday, December 24, 2013

Two Miami Women Sentenced to 10 Years in Prison for Conspiring to Pay Health Care Kickbacks

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG), Miami Regional Office, announce that U.S. District Judge Federico A. Moreno sentenced Yiral Cardona, 39, of Miami, and Susan Chi, 42, of Miami, to 10 years in prison, stemming from their leadership roles in a conspiracy to pay health care kickbacks.
At trial, Cardona and Chi were convicted on October 22, 2013, of one count of conspiracy to pay health care kickbacks and to defraud the United States, in violation of Title 18, United States Code, Section 371, and three counts of unlawful payment of health care kickbacks, in violation of Title 42, United States Code, Section 1320a-7b(b)(2)(A).
According to the evidence presented at trial and the sentencing hearing, Cardona and Chi owned Vista Home Health Services Inc. (Vista), a Miami-Dade based home health agency that purportedly provided skilled nursing and home health services to Medicare beneficiaries. The defendants illegally obtained Medicare patients by paying bribes and kickbacks of at least $141,000 to patient recruiters to induce the referral of Medicare patients to Vista for home health services. Cardona and Chi billed the Medicare program for home health services that were not medically necessary and/or not provided. Between approximately May 15, 2009 and April 26, 2012, Medicare paid Vista more than $4.1 million in claims. The court ordered the defendants to pay more than $733,000 in restitution.

Friday, December 20, 2013

Denial - Why Alcoholics and Drug Addicts Think It's OK to Drink and Use Drugs

Denial is a defense mechanism that allows a person - despite overwhelming evidence to the contrary - to deny that something is true, when in fact, it is true. It is one of the most powerful and difficult problems that Alcoholics and Drug Addicts face before, during, and after treatment, because it is always the thinking that precedes the act of picking up a drink or a drug.

Physical Components of Denial

Over the course of time, drinking and using drugs can cause changes in the brain that affect thought processes and emotions. For example, when the hippocampus, which controls memory and judgment, is damaged, the Alcoholic or Addict has great difficulty remembering the bad things that happen when they drink or use. This coupled with impaired judgment allows them to actually believe that drinking or using drugs is ok.

Poor judgment is further compounded by the over stimulation or inhibition of two important neurotransmitters: Serotonin and Dopamine. Serotonin affects thinking and emotions, while Dopamine affects the pleasure and reward center of the brain. When a person drinks or uses drugs excessively, these neurotransmitters are over stimulated, and the body develops a tolerance to them. This causes the individual to need more and more of the substance while they get less and less of an effect.

Non-addicted people find it very difficult to understand the actions and thinking of the addict or alcoholic. They just don't "get it" because their brains have not been damaged so their thinking is not organically impaired and they have the capacity to differentiate between truth and falsehood.

Thought Patterns of Denial

The essential and most basic of all Denial thinking is this: "I don't have a problem with alcohol or drugs, and the things that are wrong in my life don't have anything to do with my drinking or using." This erroneous belief gives rise to all sorts of strange twists and turns of thought that are common in Addicts and Alcoholics.

Substance Abusers blame others for the negative things that happen in their lives and lie about where they have been and what they have been doing. They live in a fantasy world where they have convinced themselves that their lives are "not so bad" despite the loss of jobs, marriages, family and friends. They say that if only they had more money or if the people in their lives would understand them, that everything would be ok.

They do not acknowledge, nor do they connect the fact that drinking and using drugs have become the root cause of their current problems; this is Denial.

Behavior Patterns of Denial

Family, friends and employers notice changes in the behavior of an alcoholic or addict long before the person with the disease does. This is the first indicator that someone is in denial about their disease. Tragically, as it progresses, the individual barely notices the changes and deterioration because they happen gradually, day after day and seem normal to the sufferer.

Typical behaviors include, but are not limited to: being late to work, inability to hold a job, getting arrested, ending relationships when people criticize their drinking or using, spending rent money on drugs or alcohol, not keeping commitments, driving under the influence, poor personal hygiene, frequenting dangerous neighborhoods, and living on the street.

Again, the alcoholic or addict does not notice or pretends not to notice that these behaviors are related to their substance abuse, when clearly they are.

Summary

Denial is one of the biggest roadblocks to recovery. It is an elusive and dangerous pattern of thinking that is extremely difficult to break because it has so many different causes and manifestations. The first clue that someone is in denial is that their behavior and dialog changes dramatically and they develop a litany of excuses for this that do not include drinking or using drugs.

This is further compounded by physical damage to the brain and its chemistry, which exacerbates poor judgment, increases tolerance, and enhances denial. The fundamental problem of denial is that the alcoholic/addict actually sees their substance abuse as the cure, not the cause.

It is only when a person has a moment of clarity; where they see through the fog of denial and connect their problems to their drinking or using drugs that they will seek help. When this happens, recovery is possible.

Wednesday, December 18, 2013

New Jersey Opthalmologist Admits Lying to Federal Agents During Fraud Investigation About Reuse of Lucentis Vials

NEWARK—An ophthalmologist with a medical practice in Englewood, New Jersey admitted today to lying to federal agents during a health care fraud investigation into the reuse of single-use vials of prescription Lucentis medication for multiple patients, U.S. Attorney Paul J. Fishman announced.
Bernard J. Fowler, 68, of Mahwah, New Jersey, pleaded guilty to an information charging him with making false statements to federal agents with the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG). He entered his plea before U.S. District Judge Susan D. Wigenton in Newark federal court.
According to documents filed in this case and statements made in court:
Fowler was a licensed and board-certified ophthalmologist operating his own medical practice called Retina Vitreous Consultants, when he was interviewed by HHS-OIG special agents on July 27, 2011. Fowler no longer operates the practice.
During his guilty plea, Fowler admitted that in 2008 and 2009, he had administered injections from one vial of Lucentis to more than one patient on multiple occasions but told the investigating agents that he had not. Fowler admitted he knew the statement was false and he intended to deceive the agents.
In addition to the potential health risks of reusing single-use vials on multiple individuals, such reuse can generate fraudulent billings to patients and insurers based on the approximately $2,000 cost of a full vial.
The false statements charge carries a maximum potential penalty of five years in prison and a $250,000 fine, or twice the gain or loss caused by the offense. Sentencing is scheduled for March 24, 2014.
U.S. Attorney Fishman credited special agents of HHS-OIG, under the direction of Special Agent in Charge Thomas O’Donnell, and the FBI, under the direction of Special Agent in Charge Aaron T. Ford, for the investigation leading to the guilty plea.
The government is represented by Assistant U.S. Attorneys Scott B. McBride and R. David Walk of the U.S. Attorney’s Office’s Health Care and Government Fraud Unit.

Tuesday, December 17, 2013

Health and Fitness - Buying Used Fitness Equipment

If you are dedicated to your health and fitness, but are sick and tired of the time it takes to work out at the gym you might want to look into getting used fitness equipment for your home. With the right knowledge you will be able to find equipment that is in perfect condition, for a fraction of the price.
With the economy the way it is right now if you are going to buy anything you should be buying it at a discount. These steep price reductions are available because most people are selling off anything in their home, they aren't using, for extra cash. On websites like E-Bay, Overstock, or Craig's List you should be able to find just about anything you need.
There are also people who have defaulted on their finance payments for their fitness equipment. You can assume or pay off their balance to get their used machines at a steep discount.
Buy Only What You Need
Let's face it. Some of the fitness equipment out there is a bit ridiculous. You don't need half of the stuff commercials try to sell to you. What is important is that you value your own health and fitness.
Otherwise you are wasting your money, time, and space in your house or apartment. So make sure you have a solid commitment to health and fitness before you make your purchase.
For cardio workouts treadmills, rowing machines, bikes, and elliptical machines work great. You really only need one in your home to get the cardio you need so pick the machine based on the workout you enjoy doing the most.
For heavy lifting or toning of the entire body a simple used resistance machine, like the Total Gym or a Bowflex are all you need. Good workout benches, dumbbells and free weight sets are also easy to find.
Try It Out First
If you are unsure as to what kind or type of used fitness equipment you would like for your home then you should go to the gym and try some out and see what you like. Remember to make sure that it is a machine you are going to have fun using over and over again. Then look on-line and see what is available.
Also remember that most used fitness machines don't come with a warrantee, or if they do it is generally short, so you are often stuck with what you buy once you get it. Try to find some customer reviews of the product before you buy it to see if there are common problems associated with it.
Is It Going To Fit?
Believe it or not, some people don't take into account the space that is needed for fitness equipment and end up with something they don't have room for. Most fitness equipment is also quite heavy so make sure that your floor is going to be able to handle it.
If you follow the above recommendations you should be able to find the used fitness machine(s) you need. Once you have one in your home you will find that staying focused on your health and fitness is easier and more convenient.

Monday, December 16, 2013

Manhattan U.S. Attorney, FBI, and IRS Announce Charges Against Pharmacy Owner in Multi-Million-Dollar Medicare, Medicaid Fraud Scheme

Preet Bharara, the United States Attorney for the Southern District of New York; George Venizelos, the Assistant Director in Charge of the New York Field Office of the Federal Bureau of Investigation (FBI); and Toni Weirauch, the Special Agent in Charge of the New York Field Office of the Internal Revenue Service-Criminal Investigation (IRS-CI), announced that Purna Chandra Aramalla was arrested yesterday for engaging in a scheme to defraud Medicaid and Medicare through the sale of illegally diverted prescription drugs. Aramalla was also charged with a related money laundering offense. Aramalla was arrested yesterday morning and was presented in Manhattan federal court before U.S. Magistrate Judge Debra Freeman yesterday afternoon. A preliminary hearing is scheduled for January 13, 2014.
Manhattan U.S. Attorney Preet Bharara said, “The illegal diversion of prescription medications threatens the health of those induced to sell their medication rather than take it. It threatens the health of those who unwittingly purchase the repackaged drugs believing them to be factory-fresh. And, as alleged here, Purna Aramalla’s diversion scheme defrauded millions of dollars from Medicare and Medicaid, taxpayer-funded programs established to provide health care assistance for the elderly and indigent. This office is committed not only to punishing and preventing fraud, and safeguarding Medicare and Medicaid, but also to protecting the public.”
FBI Assistant Director in Charge Venizelos said, “As alleged in the complaint, Aramalla conspired to defraud our government health care programs and profit from the illness and misfortune of others. Aramalla treated our American health care system as a vehicle to fuel his greed and line his own pockets. The FBI, in conjunction with our law enforcement partners, will continue to investigate and bring to justice criminals who bilk the system and defraud the American taxpayer.”
IRS-CI Special Agent in Charge Weirauch said, “The illegal sale of prescription drugs by pharmaceutical professionals is an escalating problem. Not only does it put potentially dangerous medications in the wrong hands, but fraudulent Medicare and Medicaid reimbursements divert resources from the government. The money laundering statutes have always been effective tools in the fight against illegal drugs. We are now applying these same laws to the illegal prescription drug business, tracing the lucrative proceeds that the sales of these drugs generate.”
According to the allegations contained in the criminal complaint unsealed today:
Aramalla operates A Fair Deal Pharmacy Inc. in Queens, New York, and Quality Health Drug Inc. in Bronx, New York. Using these pharmacies, Aramalla allegedly carried out a multi-million-dollar scheme to defraud New York State Medicaid and Medicare programs through the sale of diverted pharmaceutical drugs, that is, drugs not obtained from legitimate sources.
As part of the scheme, Aramalla purchased pharmaceuticals, including high-cost medications used to treat HIV, that were obtained from patients who sold the pharmaceuticals rather than use them to treat their illnesses. Aramalla then repackaged and resold those pharmaceuticals to his customers, as if the pharmaceuticals were new drugs obtained from legitimate sources. Aramalla requested and received reimbursement from Medicaid and Medicare in connection with these sales, even though Medicaid and Medicare would not have been willing to reimburse the cost of second-hand drugs. In addition, in some cases, Medicaid or Medicare had already paid for the pharmaceuticals when they were initially dispensed. In order to make the diverted pharmaceuticals appear to be new pharmaceuticals from legitimate sources, Aramalla and his co-conspirators used lighter fluid and other means to dissolve the adhesive on the patient labels on prescription bottles so that they could be removed and replaced with new labels.
Aramalla also sought and obtained reimbursement for pharmaceuticals that were never actually dispensed to patients. Instead, customers with prescriptions for pharmaceuticals essentially “sold” their prescriptions to Aramalla, agreeing not to take delivery of the pharmaceuticals in exchange for a share of the reimbursed proceeds.
From October 2010 to August 2012, Aramalla purchased approximately $1.7 million of certain branded HIV medications from two legitimate, licensed wholesalers that were his primary sources of legitimate drugs. During that same period, he received approximately $4.3 million in reimbursements from Medicare and Medicaid for those same drugs, an amount far in excess of what he would have been entitled to had he only sought reimbursement for the legitimately obtained drugs.
* * *
Aramalla, 65, of Port Washington, New York, is charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum term of 20 years in prison, and one count of money laundering, which also carries a maximum term of 20 years in prison. He was ordered detained pending satisfaction of bail conditions, including a $2 million personal recognizance bond.
Mr. Bharara praised the outstanding investigative work of the FBI and the IRS. He also thanked the U.S. Department of Health and Human Services, Office of Inspector General; the New York State Office of Medicaid Inspector General; and the New York City Human Resources Administration.
The New York FBI Health Care Fraud Task Force was formed in 2007 in an effort to combat health care fraud in the greater New York City area. The task force comprises agents, officers, and investigators from the FBI, NYPD, the New York State Insurance Fraud Bureau, U.S. Department of Labor, U.S. Office of Personnel Management-Inspector General, U.S. Food and Drug Administration, New York State Attorney General’s Office, New York State Office of Medicaid Inspector General, New York State Health and Hospitals Inspector General, and the National Insurance Crime Bureau.
If you think you may have purchased second-hand prescription drugs or were otherwise victimized by this scheme, you can call the FBI Hotline at 212-384-3555.
The case is being prosecuted by the Office’s Complex Frauds Unit. Assistant U.S. Attorney Niketh Velamoor is in charge of the prosecution.
The charges contained in the complaint are merely accusations, and the defendant is presumed innocent unless and until proven guilty.

Saturday, December 14, 2013

What Are the Options for Alcohol Addiction Recovery?

You have many options available to you on your path to alcohol addiction recovery. There are traditional treatment programs and aftercare services. However, there are also less known alternative recovery options that can help you maintain sobriety.

Traditional programs include treatment centers. Residential treatment centers are perfect for teenagers. Adults who do not have a support system can benefit froma residential treatment center. Other inpatient programs can help alcohol dependent individuals, particularly hospital-based services. If you have to go through detox, a hospital inpatient program is ideal because medical professionals are on hand to help you through the physical symptoms of withdrawal.

Outpatient programs may be more suitable if you have a job or other daily responsibilities. Outpatient programs help you maintain sobriety through individual and group counseling. The program is your life line to recovery. It helps you deal with problems on a daily or weekly basis as you rebuild your relationships.

Outdoor therapy programs are available for teenagers and adults. These programs integrate outdoor physical activities in the recovery process. You learn to appreciate nature while developing team building skills. You begin to take responsibility for your actions and learn how your actions impact others. This helps you understand the impact of alcohol abuse on your relationships. Your self-esteem improves through achievement of physical challenges.

You have your choice of religious-based and secular programs. If it is important for you to reaffirm your faith or to establish a relationship with a higher power, religious-based programs may be the best option for you. Secular programs allow you to heal yourself before you start contemplating your spirituality.

A new trend in alcohol addiction recovery is online counseling and social networks. Most web sites dedicated to recovery communities usually charge a membership fee to join. Others require payment if you want to ask a specific question. Some sites are more of a social network for support while others actually create treatment plans for members. These sites are great for ongoing distance support. If you decide to use this option, be sure the site is managed by a certified addiction counselor.

Twelve-step programs such as AA remain popular options for alcohol addiction recovery. These are community-based groups that provide ongoing support to members. Regardless of the option you choose, by participating in a treatment or support program, you have a better chance of achieving recovery and maintaining sobriety.

Wednesday, December 11, 2013

Former Doctor Sentenced to Home Detention on Health Care Fraud Convictions

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced that former medical doctor Daniel C. Gillick, 63, of Youngstown, New York, who previously pleaded guilty to obtaining controlled substances by fraud and health care fraud, was sentenced today to six months of home detention and two years’ probation. As a part of the plea, the defendant surrendered his medical license.
Assistant U.S. Attorney Timothy C. Lynch and Maura K. O’Donnell, who handled the case, stated that between August 2011 and September 7, 2011, the defendant was employed as an emergency room physician at Schuyler Hospital. During that time, Gillick devised a scheme whereby on September 7, 2011, his then-girlfriend, Christine Guilfoyle, reported to the emergency room at Schuyler Hospital and pretended to suffer from a medical condition known as trygeminal neuralgia. The defendant then performed an apparent examination of her, fraudulently diagnosed her as suffering from trygeminal neuralgia and issued a prescription to her for Dilauded, a controlled substance.
In reality, Gillick's girlfriend was not suffering from this condition and had no medical need for the drug Dilaudid. In participating in this illegal scheme, the defendant defrauded Schuyler Hospital and also aided and abetted his former girlfriend in obtaining a controlled substance by fraud.
“This office has previously spoken about the need for all segments of the community to understand and help combat the dangers associated with the illegal trafficking in painkillers,” said United States Attorney Hochul. “Doctors and other medical professionals need to also understand that this office will not hesitate to bring criminal charges against them when warranted by the facts and the law.”
On November 22, 2013, U.S. Magistrate Judge Hugh B. Scott sentenced Christine Guilfoyle to time-served for her misdemeanor conviction for possessing cocaine base.
These cases are the result of an investigation on the part of special agents of the United States Drug Enforcement Administration, under the direction of Brian R. Crowell, Special Agent in Charge, New York Field Division; special agents of the Federal Bureau of Investigation, under the direction of Special Agent in Charge Brian P. Boetig; the New York State Police, under the direction of Major Michael Cerretto; Customs and Border Protection, under the direction of James Engleman, Director of Field Operations; the New York State Attorney General Medicaid Fraud Control Unit; the Amherst Police Department, under the direction of Chief John Askey; the Buffalo Police Department, under the direction of Commissioner Daniel Derenda; the Lancaster Police Department, under the direction of Chief Gerald Gill; the Erie County Sheriff's Department, under the direction of Sheriff Timothy Howard; the Depew Police Department, under the direction of Chief Stan Carwile; and the Niagara County Sherif's Drug Task Force, under the direction of Sheriff James Votour.

Sunday, December 8, 2013

Post Acute Withdrawal Syndrome and Addiction Treatment: The Little Known Obstacle to Recovery

Addiction Treatment professionals agree that Post-Acute Withdrawal Syndrome (P.A.W.S.) is one of the most difficult challenges that Alcoholics or Addicts face in the early stages of their recovery. It is a multi-faceted group of symptoms that cause the individual to crave a drink or a drug even though everything is going well for them and they are following through with all their recommended post treatment activities. Unfortunately, this relapse precursor is especially difficult to deal with, because it is not emphasized enough by most treatment centers during treatment; without education about this topic, the substance abuser has no defense against it.

The discomfort of the initial withdrawal from drugs or alcohol is managed through a medical detoxification process commonly referred to as "detox". Symptoms are minimized during the initial 3 to10 day period when the body is in acute withdrawal and adjusting to not having these substances. Detoxification does not eliminate all of the substances from the body, nor does it repair the damage to brain, organs, central nervous system, or neurotransmitters that have been caused by drinking and drug abuse.

The biggest mistake that alcoholics and addicts make is to think that the detoxification process is the end of the withdrawal process; that once you leave detox all of the substances are out of the body and you're cured. Nothing could be further from the truth; detoxification actually sets the stage for the onset of Post-Acute Withdrawal Syndrome.

Post Acute Withdrawal Syndrome - What it is and Why it Happens

After detoxification, for reasons science doesn't completely understand, the body can react as if it was still on drugs. One part of the explanation for this phenomenon is the body's own natural cleansing process. As it flushes the chemical remnants of alcohol and drugs from organs and intramuscular hiding places, it hits the bloodstream and triggers a physical craving - much like the sensation of smelling popcorn and then wanting to see a movie.

In addition to this physical component, any type of mental, emotional or physical stress can trigger a desire to drink or use drugs. When an alcoholic or addict feels pain or is stressed out, they remember one thing: if they pick up a drink or a drug, the pain and stress will go away. This is because the area of the brain that affects judgment has been damaged and they do not remember how bad things were. Most importantly, they do not connect their substance abuse to what they are feeling at that moment, and so they very often relapse.

Symptoms of Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome produces a wide variety of side effects and symptoms that make no sense to the addict experiencing them, or to the friends, family and employers observing them.

These symptoms include but are not limited to:
Lack of coordination
Walking into things
Dropping things
Thinking "I'm crazy"
Feeling scared
Forgetting things
Impaired judgment
Disorientation
Anxiety
Insomnia
Irritability
Craving
Mood swings
Anger
Depression
Increased sensitivity to pain

Summary

Post Acute Withdrawal Syndrome is a disconcerting yet normal part of the recovery process. Thankfully these symptoms disappear over time, and in most cases the brain and body damage is repaired. The difficulty for someone in the early stages of recovery is that these feelings, thoughts and physical side effects can be so overwhelming that they trigger a desire to drink or use drugs again just to get relief and when they do this, they start the vicious cycle all over again.

Friday, December 6, 2013

Manhattan U.S. Attorney and FBI Assistant Director in Charge Announce Health Care Fraud Charges Against Current and Former Russian Diplomats and Their Spouses

Preet Bharara, the United States Attorney for the Southern District of New York, and George Venizelos, the Assistant Director in Charge of the New York Field Office of the Federal Bureau of Investigation (FBI), today announced charges against 49 defendants for participating in a widespread fraud scheme from 2004 to August 2013 to illegally obtain nearly half-a-million dollars in Medicaid benefits. Each of the defendants charged in the complaint unsealed today is a current or former Russian diplomat or the spouse of a diplomat employed at either the Russian Mission to the United Nations (the Mission), the Russian Federation Consulate General in New York (the Consulate), or the Trade Representation of the Russian Federation in the USA, New York Office (the Trade Representatio”). The complaint alleges that each of the defendants and their unnamed co-conspirators participated in a widespread scheme to illegally obtain Medicaid benefits for prenatal care and related costs by, among other things, falsely underreporting their income or falsely claiming that their child was a citizen of the United States.
Manhattan U.S. Attorney Preet Bharara said, “Diplomacy should be about extending hands, not picking pockets in the host country. Here, as alleged, a multitude of Russian diplomats and their spouses ran a scam on a health care system designed to help Americans in need. As the complaint alleges, the scam exploited a weakness in the Medicaid system, and the charges expose shameful and systemic corruption among Russian diplomats in New York.”
FBI Assistant Director in Charge George Venizelos said, “The United States government values its long-standing relationship with foreign diplomats and diplomatic establishments for cooperation on many issues. Unfortunately, as detailed in the complaint, some Russian officials in New York allowed these defendants to take advantage of that relationship.
"Motivated by greed and the purchase of high-end luxury items, these defendants allegedly perpetrated a fraud to illegally obtain Medicaid benefits to which they were not entitled. The unsealing of the complaint today highlights the criminal activities of these defendants and reminds the public that health care fraud remains an ongoing problem in our country. The FBI and our law enforcement partners, including the New York City Human Resources Administration and the New York State Department of Health, are committed to preventing and prosecuting health care fraud at all levels.”
According to the allegations in the complaint unsealed today in Manhattan federal court:
Medicaid is a largely federally funded program in the United States designed to assist low-income families afford health care. In New York State, the Department of Health administers the Medicaid program, and the New York City Human Resources Administration oversees the program and processes applications in New York City. In New York State, pregnant women can receive immediate prenatal care following a preliminary assessment of the pregnant woman’s and, if applicable, her spouse’s, income. If the pregnant woman provides an income level that is higher than the Medicaid eligibility threshold, the provider will generally not process the Medicaid application. Proof of United States citizenship is not required for a pregnant woman to receive Medicaid benefits because the unborn child is presumed to acquire United States citizenship by virtue of being born in the United States. Once completed, the pregnant woman is entitled to Medicaid benefits pursuant to the original application until the 60th post-partum day, and the newborn child is entitled to benefits on the mother’s initial application until the child’s first birthday. Diplomats, their spouses, and their children are generally not entitled to Medicaid benefits except in cases of emergency.
While in the United States, the individuals employed by the Mission, Consulate, and Trade Representation are paid a salary by the Russian government, which is not subject to United States federal, state, or local taxes. Employees of the Mission and Consulate generally live in housing, the vast majority of which is paid for by the Russian government. The Mission and Consulate historically have also paid for the medical expenses of their employees, including hospital and doctor bills, as well as dental expenses. Each of the defendants named in the Complaint is a Russian diplomat who works or worked at the Mission, Consulate, or Trade Representation, or was married to such an individual. As a result of an international convention among multiple nations and a bilateral agreement between the United States and Russia, children born in the United States to Russian diplomats generally do not acquire United States citizenship.
The investigation revealed the widespread submission of falsified applications for Medicaid benefits associated with medical costs for prenatal care, birth, and young children by the defendants, which enabled the defendants to obtain Medicaid benefits that they were not otherwise entitled to receive. Approximately $1,500,000 in fraudulently received benefits were obtained by the defendants and dozens of other co-conspirators not named in the complaint. In general, the defendants underreported their income to an amount below or at the applicable Medicaid eligibility level in order to qualify for Medicaid benefits. In support of the underreported income, the defendants generally submitted letters signed by employees of the Mission, Consulate, or Trade Representation, purporting to corroborate that the falsely underreported income was the true income amount. The defendants’ true income was often hundreds, if not thousands, of dollars more per month than what was falsely reported to Medicaid. Moreover, before, during, and after the time that the defendants received Medicaid benefits, several of the defendants opened credit card accounts in which they reflected salaries thousands of dollars higher than they reported to Medicaid.
In addition, one set of defendants failed to disclose their marriage on their initial Medicaid application—falsely claiming that they were brother and sister instead of husband and wife. As a result, those defendants failed to disclose any income the husband earned from the Mission. Because of their lies, they received almost $21,000 in Medicaid income to which they were not entitled. Three other defendants falsely claimed that their children—Russian nationals residing in the United States pursuant to visas issued by the Department of State reflecting their Russian citizenship—were citizens of the United States in order to obtain Medicaid benefits for their children. To support these lies, a United States Social Security card was provided for one application, and both a United States Social Security Card and a birth certificate issued by the New York City Department of Mental Health and Hygiene was provided in support of another application.
Moreover, before, during, and after the time that the defendants applied for and received hundreds of thousands of dollars in Medicaid benefits, they spent tens of thousands of dollars on luxury items, including cruise vacations and purchases such as watches, shoes, and jewelry, at stores such as Tiffany & Co., Jimmy Choo, Prada, Bloomingdale’s, and Burberry.
For example, Timor Salomatin, a former diplomat at the Mission, and his wife, Nailya Babaeva, applied for Medicaid pregnancy benefits in November 2010 and represented Salomatin’s salary to be $3,000 a month and submitted a renewal application in June 2011 in which they claimed that Salomatin made $4,400 a month. In support of both applications, they submitted a letter signed by Mikhail Korneev, formerly a counselor at the Mission, in which Korneev falsely confirmed the underreported income amount. However, beginning in June 2011, Salomatin began to receive direct payroll deposits from the Russian government into his bank account. Between June 2011 and December 2011, Salomatin received an average of $5,160 a month—over $2,000 more than he reported to Medicaid on the initial application. In February 2011, shortly after Salomatin and Babeva applied for Medicaid benefits, and shortly before they applied for renewal benefits, Salomatin applied for a credit card and represented his salary to be $8,333 a month. In December 2011, while Babeva’s and Salomatin’s children continued to receive Medicaid benefits, Salomatin represented his salary to be $60,000 a year, or $5,000 a month. During the period between February 2012 and December 2012, while their children continued to receive Medicaid benefits, Salomatin and Babeva made and paid for over $50,000 in purchases, including over $8,400 from Apple and over $10,000 from retailers, including, among others, Prada and Bloomingdale’s. Babaeva and her children obtained almost $31,000 in Medicaid benefits to which they were not entitled.
Andrey Artasov and Nataliya Artasova falsely represented to Medicaid that Artasov made only $2,900 a month (or approximately $34,800 a year) in salary in November 2008. In March 2007—over a year-and-a-half prior to Artasova applying for Medicaid, Artasov reported to a credit card company that he made $60,000 a year in salary. In 2008, the year that Artasova received Medicaid benefits, Artasov and Artasova made and paid for over $48,000 in purchases on this credit card, spending thousands of dollars at Swarovski and Apple, among other things.
* * *
Each of the defendants was charged with one count of conspiracy to commit health care fraud and one count of conspiracy to steal government funds and make false statements relating to health care matters, which carry maximum sentences of ten years and five years in prison, respectively.
Of the 49 defendants, 11 are currently in the United States. Five of those individuals are diplomats working at the Mission. Five of those individuals are the spouses of the diplomats. One is currently employed at the Russian Federation’s embassy in Washington, D.C., but at the time of the charged offenses was employed at the Consulate. The remaining 38 no longer reside in the United States.
Manhattan U.S. Attorney Bharara praised the investigative work of the FBI and thanked the New York City Human Resources Administration and the New York State Department of Health for their assistance in this investigation.
The Office’s Public Corruption and Terrorism and International Narcotics Units are handling the case. Assistant U.S. Attorneys Rebecca Ricigliano, Shane Stansbury, and Ian McGinley are in charge of the prosecution.
The charges contained in the complaint are merely an accusation, and the defendants are presumed innocent unless and until proven guilty.
- Press conference remarks prepared for FBI New York ADIC George Venizelos

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Tuesday, December 3, 2013

Health Care Clinic Owners Sentenced for Roles in $8 Million Health Care Fraud Scheme

WASHINGTON—Two health care clinic owners were sentenced today in connection with an $8 million health care fraud scheme involving the now-defunct home health care company Flores Home Health Care Inc.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office, and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement.
Miguel Jimenez, 43, and Marina Sanchez Pajon, 29, both of Miami, were sentenced by U.S. District Judge Ursula Ungaro in the Southern District of Florida. Jimenez was sentenced to serve 87 months in prison, and Pajon was sentenced to serve 57 months in prison. Jimenez and Pajon pleaded guilty in August to conspiracy to commit health care fraud.
Jimenez and Pajon, who are married, were owners and operators of Flores Home Health, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.
According to court documents, Jimenez and Pajon operated Flores Home Health for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or not provided. Jimenez’s primary role at Flores Home Health involved controlling the company and running and overseeing the schemes conducted through Flores Home Health. Both Jimenez and Pajon were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims to the Medicare program.
Jimenez, Pajon, and their co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Flores Home Health for home health and therapy services that were medically unnecessary and/or not provided. They also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications, and other documentation. Jimenez, Pajon, and their co-conspirators used the prescriptions, medical certifications, and other documentation to fraudulently bill Medicare for home health care services, which Jimenez and Pajon knew was in violation of federal criminal laws.
From approximately October 2009 through approximately June 2012, Flores Home Health was paid approximately $8 million by Medicare for fraudulent claims for home health services that were not medically necessary and/or not provided.
The case was investigated by the FBI and HHS-OIG and 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 Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to http://www.stopmedicarefraud.gov.

Saturday, November 30, 2013

The Grieving Process and Its Importance to Addiction Recovery

This paper will address the importance of the grieving process to sustaining addiction recovery. In order to accomplish this I will utilize several sources which discuss the grieving process, including Elizabeth Kubler-Ross's stages of grieving, J. William Worden's book called "Grief Counseling and Grief Therapy", and Robert Helgoe's book "The Hierarchy of Recovery". Additionally, some personal and professional experience will also be included.

There are three reasons that the grieving process is important to sustained, rewarding recovery. The first is many addicts have unresolved grief issues from their pasts. Perhaps the death of a relative or the dissolution of a close personal relationship has occurred. The use of drugs and alcohol hamper the grieving process, resulting in a delayed grief reaction. The loss is not grieved until the addictive use of drugs and alcohol has ceased and the feelings surrounding the loss are felt and processed.

A second reason that grieving is important to recovery is the result of the losses that occur due to addictive use. Many recovering addicts grieve time they have lost with family, time lost in or starting their careers, and possibly potentials or opportunities that were lost. Recovering addicts compare their progress in their lives to that of non-addicted peers, and they appear to fall short. Their peers have moved on in their careers, have had and raised families, and have many amenities that a person new to recovery may lack.

In order to discuss the third reason that the grieving process is essential to rewarding recovery I must first introduce a theory from Helgoe's book, "Hierarchy of Recovery". Helgoe divides recovery into two phases. The push phase is defined by the focus of motivation, which in this case is toward the crisis or events which led to treatment. More concisely, the recovering addict is staying clean to avoid the consequences they experienced due to active addiction. Their motivation is largely to avoid the life they were living, being pushed from an old life to a new.

In the pull phase the recovering person is drawn toward a more spiritual and fulfilling life. The focus of recovery is no longer avoidance of an old way of living, but attraction to a new way of being, and enjoyment of the rewards of recovery in the present. Furthermore, focus on continued self-discovery, and eventually self-expression are the focus.

Helgoe believes that in order to move into the pull phase of recovery, in which the rewards of recovery are found, a person must complete the grieving process for their addiction. Facing the fact that the use of a substance such as alcohol or drugs can never be relied upon again is a painful experience for any addict. The reality of living the rest of your life without drugs and alcohol is sometimes nearly impossible to fathom to those dependent upon them. When an addict gives up substances they are giving up a friend, a lover, and possibly the only relief they know. True acceptance of powerlessness over substances is a true loss. And according to Kubler-Ross, an authority on grief and grieving, we experience grief whenever we lose anything of importance.

As identified by Kubler-Ross, there are six stages of grieving. They are:
Shock: the inability to grasp the situation as it is presented. The information is too overwhelming to process. Usually lasts only a few minutes.
Denial: a belief that the news can not be correct, due to the pain associated with the loss.
Anger: diminishes the experience of the pain that comes with the loss. Can occur at person or thing lost, at God, or at self.
Bargaining: hope leads to bargaining, a defense mechanism that delays the pain of the loss temporarily, until the hope is extinguished.
Depression: works to dull the pain of the loss because it dulls nearly all experience, internal and external. (Hierarchy of Recovery, pgs 56-59)

According to Helgoe, "at this point people go in one of two directions: they either continue defending against the pain or they drop their defenses and experience the pain." If they choose to continue to defend against the pain and not experience it, they "may resort to previously used (defenses, denial, anger, bargaining) and enter into what can be termed extended or chronic grief, a life debilitating situation often misdiagnosed". (pg59-60)
Acceptance: the acceptance of the pain associated with the loss.

In the book "Grief Counseling and Grief Therapy" by J. William Worden, the grief process is divided into four tasks, all of which relate to the stages of grief previously mentioned. They are described in the following:
Task I- Accept the reality of the loss.

During this phase the denial of the loss, including denial regarding the meaning of the loss and/or the irreversibility of the loss are resolved. Relates to shock, denial, and bargaining.
Task II- Working through the pain.

During this phase the grieving work in relation to the pain is processed and resolved. Avoiding the pain prolongs the process, as does avoiding the anger. People avoid anger due to feeling guilty, such as being angry at deceased or at God. In relation to addiction, the recovering addict may be angry with God for making them an addict, angry with the disease of addiction, angry at themselves for being an addict, and angry at those who can drink or use socially. They may have pain related to not being able to use again, and the acceptance of powerlessness may hurt their image of self worth. Relates to anger and depression.
Task III- Adjustment to the environment.

During this phase the individual may need to re-identify him or herself and take on new roles.
Relates to the beginning of acceptance.
Task IV- Emotional relocation of the loss.

The emotional energy once tied to the loss is relocated. This is the final task, and as it relates to recovery the individual has now accepted the loss. Relates to the acceptance stage. This would lend itself to entering the pull stage of recovery, as identified by Helgoe.

There are an array of feelings that are considered normal in the grieving process. These include but are not limited to: sadness, anger, guilt and self reproach, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, and numbness.

There are several complications that can occur during the grieving process. These include:
Delayed grief -the immediate emotional response is insufficient to the loss. (Grief Counseling and Grief Therapy)
Extended grief -emotional flatness, feelings of guilt.
Chronic grief -the continued use of defenses and not dealing with the pain associated with grief results in this. (Hierarchy of Recovery, pg65).

Friday, November 22, 2013

Owner of Home Health Companies Sentenced for Role in $20 Million Health Care Fraud Scheme

WASHINGTON—The owner and operator of several Miami health care agencies was sentenced today to serve 120 months in prison for his role in a health care fraud scheme involving defunct home health care company Trust Care Health Services Inc.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office; and Acting Special Agent in Charge Michael J. DePalma of the Internal Revenue Service-Criminal Investigation’s (IRS-CI) Miami Field Office made the announcement.
Roberto Marrero, 60, of Miami, was sentenced by U.S. District Judge K. Michael Moore in the Southern District of Florida. In September 2013, Marrero pleaded guilty to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.
Marrero was an owner and operator of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.
Co-conspirators Sandra Fernandez Viera, 49; Patricia Morcate, 34; and Enrique Rodriguez, 59, all of Miami, have also pleaded guilty to related charges, including conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks. On November 13, 2013, Fernandez Viera was sentenced to serve 120 months in prison; Morcate was sentenced to serve 60 months; and Rodriguez was sentenced to serve 57 months.
Together with Marrero, Fernandez Viera was an owner and operator of Trust Care. Morcate worked at and was an investor in Trust Care. Rodriguez served as a patient recruiter on behalf of Trust Care.
According to court documents, Marrero and his co-conspirators operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
Marrero primarily controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company. Marrero was also responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims to the Medicare program.
Marrero and his co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided. Marrero and his co-conspirators at Trust Care also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation. Marrero and his co-conspirators used these prescriptions, medical certifications, and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero knew was in violation of federal criminal laws.
From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services. Medicare paid Trust Care more than $15 million for these fraudulent claims.
Marrero and his co-conspirators have also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million. Those agencies include A&B Health Services Inc., Centrum Home Health Care Inc., Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Nursemed Home Care Corp., R&M Health Care Inc., Ubieta Health System Inc., and Vital Care Home Health Services Inc.
The case was investigated by the FBI and HHS-OIG, with the assistance of IRS-CI, and was brought as part of the Medicare Fraud Strike Force initiative, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Durable Medical Equipment Clinic Owner Pleads Guilty in Miami for Role in $11 Million Health Care Fraud Scheme

WASHINGTON—The former owner of a defunct durable medical equipment (DME) clinic based in Miami pleaded guilty today for his role in an $11 million Medicare fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office, and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations’ Miami Office made the announcement.
Francisco Enrique Chavez, 36, of Miami, pleaded guilty before U.S. District Judge Patricia A. Seitz in the Southern District of Florida to one count of health care fraud. He faces a maximum penalty of 10 years in prison when he is sentenced on February 11, 2014.
According to court records, Chavez served as the president and sole corporate officer of World Class Medical Clinic Corp. (World Class). From March 27, 2006, through August 22, 2006, Chavez submitted or caused to be submitted approximately $11,303,494 in fraudulent claims to the Medicare program on behalf of World Class for DME that was neither prescribed by a physician nor medically necessary. Medicare paid more than $1,713,959 on these fraudulent claims. The proceeds of the World Class fraud scheme were deposited into corporate bank accounts that were controlled by Chavez, and he made numerous cash withdrawals and deposits into personal and shell entity bank accounts to conceal the nature of the scheme.
Chavez was a fugitive who was extradited from Spain to Miami on August 30, 2013.
This case is being investigated by the FBI and HHS-OIG and 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 Southern District of Florida. This case was prosecuted by Trial Attorneys Allan J. Medina and Sarah M. Hall of the Fraud Section. The Criminal Division’s Office of International Affairs provided significant assistance in the extradition.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Thursday, November 21, 2013

Effectiveness of Treatment in Alcohol Addiction

Effective treatment therapy can decrease high drinking limit - it's proven to ensure it that the alcohol rehabilitation center is perfect place.

Most of the rehab centers concentrates on, recovery of the addict. This recovery can classify under four categories. Those are: life style optimization, prevention of alcoholism and physical and spiritual growth of addict.

It is noticed that, the more complex lifestyle is more or less responsible for alcoholism. During this treatment session addict can enhance his power to overcome those complexity.

Prevention - is most important part of the holistic pattern treatment. Through this session addict can achieve how to overcome those triggers which will curve him towards alcohol. It's a very crucial stage of treatment where addict need a lots of specialist, who will cross verify the explanation of the addict and guide him to get the proper think ability.

Some of rehab centers focused on physical and spiritual growth of the addict through music and yoga. It is proven that, most of the cases relapse the alcohol abuse caused the improper prevention plan. Basically it's a problem solving technique. Through which addict can overcome the "Helplessness". So the addicts need a proper substance prevention plan by providing a continuous support. Generally the holistic approach takes 1 year for continuous support.

This is recommended that, the holistic intervention process is the beginning process of the treatment, so done it carefully with specialist supervision or by taking help of any rehab center. Sometimes detoxification is required; detoxification is a process - where using proper medicine alcohol and damaged cell can be removed from human body. Doctors will provide cross tolerance drugs into addict's body that will effect to prevent alcohol. Detoxification may or may not be required for all addicts. Perhaps it's a good therapy used by rehab centers.

Some of rehab centers develop their treatment in reverse way. First they start detoxification then they will provide holistic therapy. Although detoxification is difficult so do the detoxification with all medical facility.

Alcohol detoxification mainly classified under two categories. First approach is medicinal approach where doctor and other medical stuff will detoxify the addicts' body, and the second approach is after completion of medicinal approach - addict should make his body completely free from alcohol by taking proper healthy food and drink.

There will be little side effect of detoxification. After detoxification person can feel little nervous or feel little bit anxiety for a few days, little difficulties with sleep for few nights, but all this for a few days. Finally, to take a decision please consults with any rehab centers for proper guidance. Proper care and treatment can minimize the side effects of detoxification process.

Federal Jury Convicts Brunswick Woman in $4 Million Medicaid Fraud Scheme

BRUNSWICK, GA—Schella Logan Hope, 47, of Brunswick, Georgia, was convicted earlier this month by a federal jury of various health care fraud, aggravated identity theft, and money laundering offenses for her role in a $4 million scheme upon the Georgia Medicaid program. Chief United States District Court Judge Lisa Godbey Wood presided over Hope’s five-day jury trial.
According to evidence presented during the trial, Hope was a licensed dietician who ran a business located in Brunswick, Georgia, known as Hope Nutritional Services. From 2005 through 2011, Hope stole the identities of thousands of needy children between the ages of zero and five that were enrolled in Head Start programs located throughout the state of Georgia. Once Hope obtained the identities of these children, Hope fabricated patient files, falsified prescriptions from doctors, and submitted $4 million worth of claims to Medicaid for nutritional services that were not provided. Hope then used the money she stole from Medicaid to pay for luxury automobiles, designer clothing, and vacations, among other things.
Co-conspirator Arlene Murrell pled guilty before Hope’s trial to her role in the scheme. Murrell testified against Hope at trial and detailed how she helped Hope commit the fraud.
Hope was convicted of 58 counts of conspiracy to commit health care fraud; health care fraud; aggravated identity theft; and money laundering. Upon her convictions for these offenses, Chief Judge Wood remanded Hope to the custody of the United States Marshals pending sentencing in the case.
United States Attorney Edward J. Tarver stated, “Defendant Hope preyed upon American taxpayers by stealing the identities of low-income Georgia families and then billing Medicaid for over $4 million in nutrition services that were never provided. This United States Attorney’s Office will continue its efforts to prosecute all who seek to defraud American taxpayers by scamming federal programs. Because of Ms. Hope’s criminal efforts to feed her extravagant lifestyle, she will have to rely upon the federal prison system for her own nutritional services.”
“The Head Start Program provides many of our nation’s children with invaluable services and opportunities,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office. “To use the Head Start Program as a vehicle to submit false and fraudulent claims to the Medicaid system is unacceptable, and the OIG will continue to pursue these kinds of egregious cases.“
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “Those who defraud our publicly funded healthcare programs such as Medicaid and Medicare are taking valuable services and resources away from those in need. This guilty verdict reaffirms that the FBI will continue to provide significant investigative resources toward identifying, investigating, and presenting for prosecution such individuals that, by engaging in such criminal conduct, put themselves before others."
Georgia Attorney General Sam Olens said, “Fraud of taxpayer monies will not be tolerated in any form. Head Start is a program intended to offer assistance to children from low income families. The fact that this defendant used the Head Start Program and children in need to assist in her scam is especially appalling.”
“The Georgia Department of Community Health has made it a top priority to ferret out fraud, waste, and abuse in our Medicaid program. Our collaborative work with state and federal agencies enables us to ensure Medicaid program dollars are being used to provide health care services to Georgia’s most vulnerable populations,” said Clyde L. Reese, III, Esq., commissioner of the Georgia Department of Community Health.
At sentencing, Hope faces 10 years in prison for each of the 17 health care fraud offenses; 20 years in prison for the various money laundering offenses; and two years consecutive prison sentences for each of the various aggravated identity theft offenses. Hope also faces up to three years of supervised release and may be ordered to pay restitution to the victims in this case.
The convictions of Hope and Murrell resulted from a joint investigation by the United States Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; Georgia’s Department of Community Health; and the Georgia Attorney General’s Medicaid Fraud Control Unit.
Assistant United States Attorneys Brian T. Rafferty and David Stewart, along with Assistant Attorney General Robin Daitch, prosecuted the case on behalf of the United States. For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.

Prominent Tri-State Cardiologist Sentenced to 78 Months in Prison in $19 Million Fraud Scheme and for Exposing Patients to Unncessary Medical Treatment

NEWARK, NJ—A well-known cardiologist and the founder, CEO, and sole owner of two large medical services companies in New Jersey and New York was sentenced today to 78 months in prison and ordered to pay $19 million in restitution for conspiring in a multi-million-dollar health care fraud scheme that subjected thousands of patients to unnecessary tests and potentially life-threatening, unneeded treatment, as well as treatment by unlicensed or untrained personnel. The sentence was announced today by U.S. Attorney Paul J. Fishman of the District of New Jersey.
Jose Katz, 69, of Closter, New Jersey, previously pleaded guilty to an information charging him with one count of conspiracy to commit health care fraud and one count of Social Security fraud arising from a separate scheme to give his wife a “no show” job and make her eligible for Social Security benefits. Judge Linares imposed the sentence today in Newark federal court.
“Katz prized illegal profits over patients to a staggering degree, committing record-breaking fraud and compromising care,” said U.S. Attorney Fishman. “Prison is an appropriate consequence for ripping off the government and insurance companies through the shocking exposure of patients to unneeded or untrained treatment.”
As part of his plea agreement with the government, Katz agreed that the loss amount sustained by Medicare, Medicaid, and other insurers victimized by the fraudulent billings was $19 million. U.S. Department of Health and Human Services-Office of the Inspector General and FBI records indicate the loss amount suffered by the victims is the largest recorded in New Jersey, New York, and Connecticut for an individual practitioner convicted of health care fraud.
According to documents filed in this case and statements made in court:
Katz was the founder, CEO, and sole equity-holder of Cardio-Med Services LLC (Cardio-Med) and Comprehensive Healthcare & Medical Services LLC (Comprehensive Healthcare). From 2004 through 2012, Cardio-Med had offices in Union City, Paterson, and West New York, New Jersey, and Comprehensive Healthcare had offices in Manhattan and Queens, New York. Both Cardio-Med and Comprehensive Healthcare provided cardiology, internal medicine, and other medical services to individual patients. During that time period, Katz conspired to bill Medicare Part B, Medicaid, Empire BCBS, Aetna, and others for unnecessary tests and unnecessary procedures based on false diagnoses and for medical services rendered by unlicensed practitioners.
Between July, 2006 and February, 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations. The ads attracted hundreds of patients to Cardio-Med and Comprehensive Healthcare every day. Overall, Katz was able to bill Medicare and Medicaid more than $75 million for his services from 2005 through 2012.
Over the course of the conspiracy, Katz ordered and performed essentially the same battery of diagnostic tests for nearly all the patients he treated, regardless of their symptoms. Katz also instructed his non-physician employees to order and perform diagnostic tests for patients of other doctors working at his offices, even though he had not examined those patients and the other physicians had not ordered the tests.
Most significantly, Katz admitted that he falsified patient charts with fictitious and boilerplate symptoms and falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina. He also admitted to making the diagnoses to justify prescribing and administering an unnecessary treatment for those patients called enhanced external counter pulsation, or EECP. Katz even prescribed EECP treatments for some patients with contraindications for the treatment, therefore subjecting those patients to a substantial risk of serious injury or death.
From 2005 through 2012, Medicare and Medicaid paid Katz more than $15.6 million just for his EECP treatments, most of which were fraudulent.
In addition, Katz ordered conspirator Mario Roncal, 62, of Woodland Park, New Jersey—who had a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but did not have a license to practice medicine in any of the 50 states—to treat patients, knowing he was not licensed. At Katz’s direction, Roncal held himself out to fellow employees and to patients as “Dr. Roncal,” examined new patients as well as Katz’s follow-up patients, ordered diagnostic tests, diagnosed patients with medical conditions and diseases, and recommended and prescribed courses of treatment and surgery—including falsely diagnosing patients with angina and prescribing EECP treatments for those patients.
To conceal this illegal and unlicensed practice of medicine, Roncal forged Katz’s signature on paperwork associated with Roncal’s unlawful medical services, including on patient charts. During the conspiracy, Katz used his own billing numbers to bill Medicare Part B and Medicaid for the illegal services Roncal provided as though they were provided by Katz.
Roncal was indicted on March 2, 2012, for conspiracy to commit health care fraud. He entered a guilty plea on January 4, 2013, and awaits sentencing.
Katz also admitted to a Social Security fraud scheme in which, from 2005 through 2012, he kept his wife on Cardio-Med’s payroll though she performed little or no work. During the course of the scheme, Katz sent false W-2 forms for calendar years 2005 through 2011 to the U.S. Social Security Administration purportedly reflecting $1,251,604 in earnings for his wife, making her eligible for an estimated $263,000 in Social Security benefits to which she was not entitled.
In addition to the prison term and restitution, Judge Linares sentenced Katz to serve three years of supervised release.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen; and criminal and civil investigators with the U.S. Attorney’s Office for the investigation leading to today’s sentence. He also thanked the Medicaid Fraud Division of the Office of the New Jersey State Comptroller for its assistance.
The government is represented by Assistant U.S. Attorney Scott B. McBride of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.

Saturday, November 16, 2013

A Teenager Needs Help For Drug And Alcohol Problems

There are times when the curve balls of life are a little more than we can handle on our own. The good news is, you are not alone and healing and treatment opportunities are readily at your disposal. Drug and alcohol addiction can creep up on the best of us, and the slavery that follows can be a period of time where darkness just seems to envelope everything around us. There is light at the end of the tunnel.

Addiction treatment can be successful when paired with love, education, diligence, community, motivation and recovery. There are a plethora of counseling agencies, therapeutic communities, specialized drug treatment programs and drug and alcohol rehabilitation centers available that offer hope, freedom and resurgence. Determination and support amongst family members is a vital component of helping addicted youths overcome dependence.

Seeking out educational, reliable information is a good first step. Gaining a better understanding of addiction and the symptoms it brings can help parents and other family members communicate more effectively and convey their love, concern and support. The first step is to get professional help; help that can offer trustworthy, unswerving guidance and therapy, both to teens and their families.

There are many options available for families who have a teen that is involved with substance and or alcohol abuse. Residential facility care is one such option which involves edification, medical care and localized treatment methods. Most programs are founded on the twelve step model, and group meetings are a central component of treatment. Many residential programs are substantially controlled in order to give residents the best possible opportunity for success and triumph over their specific addiction.

Infiltrating free time with structured events, activities, therapy sessions and group meetings allows little opportunity for addictive stumbling blocks. Teens can receive encouraging support and will have time to express themselves freely to trained, licensed professionals. In many cases, these sessions open doors of communication between youths and their family members bridging the painful gap that addiction can cause in meaningful, loving relationships.

Outpatient programs can offer success to those whose schedules and addiction may not require in-house rehabilitation, or who have already completed a more stringent residential program. Outpatient treatment offers a variety of key tools that can help families and those suffering from addiction find confidence, hope and autonomy through sober living. Outpatient services can include drug and alcohol assessments, both group and individual therapy sessions, and specialized counseling for family members. Enlightening and instructive courses on drug and alcohol addiction and methods are used to combat and treat addictions, including drug screening, and medical treatments, if necessary.

The ability to combat and find freedom against addiction and enjoy the wonder and beauty of a sober life is within reach for anyone who desires to make a change. Family members and their teens are not alone and there are facilities, professionals and treatment options that can and will bring additional support and encouragement and create a foundation of healing, not only for the addict, but to the relationships that have been damaged by the dependence. Liberty from addiction is one phone call away and the choice to restore sobriety and renew life is available to everyone. The choice and the opportunity are yours! Success awaits you!

Tuesday, November 12, 2013

Illinois Physician Indicted on Federal Charges for Allegedly Illegally Dispensing Prescription Medications

CHICAGO—A LaSalle County physician was taken into federal custody this morning after being indicted on federal charges alleging that he illegally dispensed prescription narcotics to three patients in 2012 and 2013. The defendant, Dr. Constantino Perales, was charged with 17 counts of illegally dispensing oxycodone and/or alprazolam in an indictment returned by a federal grand jury on Wednesday and made public today.
Perales, 62, of Peru, Illinois, was expected to appear at 2 p.m. today before U.S. Magistrate Judge Sidney I. Schenkier in federal court in Chicago. Perales has been in state custody on related charges, which were dismissed today by LaSalle County prosecutors. Perales’ Illinois medical license was suspended and he surrendered his DEA registration after federal and local authorities executed a search warrant at his office and he was arrested on state charges in August.
According to the indictment, Perales dispensed oxycodone and/or alprazolam outside the scope of professional practice and without a legitimate medical purpose to three different patients on 17 occasions between May 2012 and August 2013.
Each count carries a maximum penalty of 20 years in prison and a $1 million fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The arrest and charge were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Shields, Jr., Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation, Jack Riley, Special Agent in Charge of the Drug Enforcement Administration; Lamont Pugh, III, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General in Chicago; and the Peru Police Department.
The government is being represented by Assistant U.S. Attorney Lela Johnson.
An indictment contains merely charges and is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

Saturday, November 9, 2013

Five Damaging Effects of Alcoholism on Your Body

Many studies have been done on the effects of consuming high amounts of alcohol over an extended period, and they have consistently shown that alcoholism has long-term and damaging effects on your body. Below, we've listed five major consequences and the most vital organs that alcohol attacks.

1. Your Liver

Over 2 million people in the United States suffer from a form of alcoholic liver disease. The liver detoxes the alcohol and removes it from your bloodstream, preventing it from accumulating and destroying other cells and organs. However, the act of metabolizing the alcohol actually creates substances that are harmful to the liver itself. This can lead to:

  • Inflammation
  • Liver scarring
  • Liver failure
  • Death

2. Your Brain

According to the National Institute of Alcohol Abuse and Alcoholism, studies have consistently shown that people with a history of alcoholism or repeated alcohol abuse have smaller, lighter and more shrunken brains than others of the same age and gender. This shrinkage in the brain has been shown to result in several damaging conditions, including:

  • Memory loss
  • Alcoholic blackouts
  • Damage to brain cells
  • Loss of cognitive thinking skills
  • Strokes
  • Dementia

3. Your Digestive System

Excessive drinking stemming from alcohol abuse or alcoholism has also been shown to damage all parts of the digestive system. If you consume several alcoholic beverages each day, you are at a higher risk for digestive system problems, such as:

  • Chronic inflammation of the esophagus
  • Pancreatitis
  • Gastritis (inflammation of the stomach)
  • Stomach ulcers
  • Cancer (in esophagus, mouth, throat, colon and rectum)

4. Your Heart

Another damaging effect of alcoholism is heart problems and diseases. At high concentrations, alcohol has been shown to interfere with the pumping action of the heart. It has also been linked to a number of other cardiovascular problems, listed below.

  • Loss of heart's ability to beat properly
  • High blood pressure
  • Coronary artery disease (the leading cause of death in Western society)
  • Heart attacks
  • Increased risk of stroke

5. Your Immune System

Alcoholics and people who drink heavily suffer from far more infectious diseases than people who drink moderately or not at all. One study found that alcohol abusers were 15 to 200 times more likely to get tuberculosis than nonusers. In extreme cases, the body can cease to accurately distinguish self from non-self, causing the immune system to actually attack your own body.

In addition to all of the health complications of high concentrations of alcohol, the University of Maryland Medical Center estimates that alcoholism can reduce your life expectancy by 10 to 12 years.

But there is hope. When alcoholics enter recovery, many of the affected vital organs begin to repair themselves and the overall health of the patient improves.

Entering into recovery can be a frightening, painful, even dangerous process. To guard the alcoholic's safety and increase the rate of long-term recovery, the first short-term goal is often a proven detoxification program to help alleviate withdrawal symptoms and ease the detox phase. Then the next phase of rehabilitation and recovery can proceed with a better prognosis for success.