Florida Physician to Pay $26.1 Million to Resolve False Claims Allegations

WASHINGTON—Steven J. Wasserman, M.D., a dermatologist practicing in Venice, Florida, has agreed to pay $26.1 million to resolve allegations that he violated the False Claims Act by accepting illegal kickbacks from a pathology laboratory and by billing the Medicare program for medically unnecessary services, the Justice Department announced today. The settlement is the largest ever with an individual under the False Claims Act in the Middle District of Florida and one of the largest with an individual under the False Claims Act in U.S. history.
The government alleged that, in or around 1997, Dr. Wasserman entered into an illegal kickback arrangement with Tampa Pathology Laboratory (TPL), a clinical laboratory in Tampa, Florida, and Dr. José SuarezHoyos, a pathologist and the owner of TPL, in an effort to increase the lab’s referral business. Under that agreement, Dr. Wasserman allegedly sent biopsy specimens for Medicare beneficiaries to TPL for testing and diagnosis. In return, TPL allegedly provided Dr. Wasserman a diagnosis on a pathology report that included a signature line for Dr. Wasserman to make it appear to Medicare that he had performed the diagnostic work that TPL had performed. The government alleged that Dr. Wasserman then billed the Medicare program for TPL’s work, passing it off as his own, for which he received more than $6 million in Medicare payments. In addition, the government asserted that, in furtherance of his agreement with TPL, Dr. Wasserman substantially increased the number of skin biopsies he performed on Medicare patients, thus increasing the referral business for TPL.
The government further alleged that, in addition to his involvement in the alleged kickback scheme, Dr. Wasserman also performed thousands of unnecessary skin surgeries known as adjacent tissue transfers on Medicare beneficiaries. Adjacent tissue transfers are complicated and often time-consuming procedures physicians sometimes use to close a defect resulting from the removal of a growth on a patient’s skin. The government alleged that Dr. Wasserman performed many of these procedures in order to obtain the reimbursement for them and not because they were medically necessary.
“Doctors who take illegal kickbacks and perform unnecessary procedures not only put their own financial self-interest over their duty to their patients, they raise the cost of health care for all of us as patients and as taxpayers,” said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division of the Department of Justice. “The Department of Justice will not tolerate those who abuse the public health care programs to which we all contribute and on which we all depend.”
“This settlement represents a watershed achievement in our district’s civil healthcare fraud enforcement program,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida. “Schemes of this magnitude require extraordinary remedies, and we are proud to have reached such an outstanding resolution for the taxpayers and their health programs.”
The allegations resolved by today’s settlement were initiated by a lawsuit originally filed in the District Court for the Middle District of Florida by Alan Freedman, M.D., a pathologist who formerly worked at TPL. Dr. Freedman filed the lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, a private party may file suit on behalf of the United States for false claims and share in any recovery. The United States has the right to intervene in the action, which it did in this case, filing its own complaint in October 2010. Dr. Freedman will receive $4,046,000 of today’s settlement.
The United States previously settled with TPL and Dr. SuarezHoyos for $950,000 to resolve the allegations asserted against them in the same lawsuit.
“Anyone cheating patients and taxpayers should expect to pay a high price,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “Besides paying more than $26 million, Dr. Wasserman is excluded from treating patients and being paid under Medicare, Medicaid, and all other federal health care programs.”
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion.
Principal Deputy Assistant Attorney General Delery and U.S. Attorney O’Neill thanked the joint investigation team, which includes special agents with the Department of Health and Human Services-OIG and the FBI, for their efforts in the investigation of this matter.
The claims settled by this agreement are allegations only; there has been no determination of liability.
The lawsuit is captioned U.S. ex rel. Freedman v. SuarezHoyos et al., No. 04-933 (M.D. Fla.).

Social Worker Indicted for Health Care Fraud

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced today that a federal grand jury in Buffalo has returned a five-count indictment charging Nina Jafari, a licensed clinical social worker, 62, of Amherst, New York, with health care fraud. The charge carries a maximum penalty of 10 years years in prison, a fine of $250,000, or both.
Assistant U.S. Attorney Michael DiGiacomo, who is handling the case, stated that according to the indictment, the defendant defrauded Blue Cross Blue Shield of Western New York. The scheme involved Jafari submitting reimbursement claim forms to Blue Cross Blue Shield for services that were not rendered. The amount totaled approximately $125,000.
The indictment is the culmination of an investigation on the part of special agents of the Federal Bureau of Investigation, under the direction of Special Agent in Charge Christopher M. Piehota.
The fact that a defendant has been charged with a crime is merely an accusation, and the defendant is presumed innocent until and unless proven guilty.

Golden Living Nursing Homes Settle Allegations of Substandard Wound Care

ATLANTA—The United States Attorney’s Office today announced that the United States and the state of Georgia have reached a settlement with GGNSC Holdings LLC of Plano, Texas, the operator of skilled nursing facilities located in Atlanta, Georgia, to resolve allegations under the False Claims Act and the Georgia State False Medicaid Claims Act that GGNSC provided inadequate and worthless wound care services to residents at two of its Atlanta-area nursing homes. GGNSC operates nursing homes under the “Golden Living” name. GGNSC has agreed to pay $613,300 to resolve these allegations. The United States’ share of the settlement is $423,544.
Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Our office is committed to protecting our most vulnerable citizens and improving the lives of nursing home residents. By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care. This type of threat to the health and well-being of the elderly in our communities will not be tolerated.”
“Golden Living fraudulently billed Medicaid for nursing services which were substandard and, tragically, resulted in harm to patients,” said Attorney General Sam Olens. “The nursing home patients depended on Golden Living to provide them with quality wound care services to help them heal, but, instead, were mistreated. We will not stand for such egregious misconduct by a Medicaid provider.”
“Quality of care in nursing homes is a top priority for the Office of Inspector General,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.”
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI will continue to dedicate its investigative personnel and resources toward such cases of Medicaid and Medicare fraud as was seen here. These federally funded programs provide much needed services but are limited and health care providers that abuse these programs will be held accountable.”
“The Defense Criminal Investigative Service is committed to ensuring that TRICARE beneficiaries receive the high quality medical care that they deserve,” said John F. Khin, Special Agent in Charge, Southeast Field Office, Defense Criminal Investigative Service. “This settlement sends the message that providers of substandard care will be brought to justice through the collaborative efforts of law enforcement agencies and the Department of Justice.”
The government alleges that GGNSC submitted false claims to Medicare, Medicaid, and the Veterans Administration because it provided residents at Golden LivingCenter–Glenwood (GLCG) and Golden LivingCenter–Dunwoody (GLCD), f/k/a Golden LivingCenter–Northside, with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds during the period from January 1, 2006 through May 31, 2011. The claims settled in the civil settlement are allegations only, and there has been no determination of liability.
GGNSC executed a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General, which will require six GGNSC facilities in the Atlanta area (in addition to GLCG and GLCD, Golden LivingCenter–Briarwood, Golden LivingCenter–Decatur, Golden LivingCenter–Kennestone, and Golden LivingCenter–Medical Arts) to continue to implement certain policies and procedures to ensure compliance with applicable statutes and regulations governing patient care. In addition, an independent monitor was appointed to oversee operations at the six Atlanta-area GGNSC facilities for up to five years to verify that the policies and procedures are working effectively and that patients receive appropriate care.
The civil settlement resolves some of the claims in a lawsuit filed by Dr. Joseph L. Micca under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The case, pending in the Northern District of Georgia, is filed under United States & State of Georgia ex rel. Micca v. GGNSC Holdings, LLC, et al., No. 1:10-cv-1055-ODE (Northern District of Georgia, April 9, 2010). Dr. Micca will receive a share of the settlement payment that resolves certain claims in the qui tam suit that he filed.
This case was investigated by special agents of the Federal Bureau of Investigation; the U.S. Department of Health & Human Services, Office of Inspector General; the Defense Criminal Investigative Service; and the Georgia Medicaid Fraud Control Unit.
The civil settlement was reached by Assistant United States Attorneys Amy Berne and Lena Amanti.
For further information please contact the U.S. Attorney’s Public Information Office at USAGAN.Pressemails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.