Monday, December 30, 2013
Boyfriend Charged in Pregnant Teen's Killing
Suspect in 3 Colorado Slayings Captured in Okla.
Time Running Short for Teen Declared Brain Dead
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
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
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
Monday, December 16, 2013
Manhattan U.S. Attorney, FBI, and IRS Announce Charges Against Pharmacy Owner in Multi-Million-Dollar Medicare, Medicaid Fraud Scheme
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.
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
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
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.
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
Follow the FBI’s New York Office on Twitter. Sign up for our e-mail alerts to receive the latest information from the FBI’s New York Office on breaking news, arrests, and fugitives.
Tuesday, December 3, 2013
Health Care Clinic Owners Sentenced for Roles in $8 Million Health Care 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.
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.