Medical Director for Miami-Based Health Care Clinic Sentenced to 144 Months in Prison for Role in $50 Million Medicare Fraud Scheme

WASHINGTON—A former medical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced today to serve 144 months in prison for his role in a fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced 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; Michael B. Steinbach, Special Agent in Charge 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.
Dr. Gary Kushner, 72, of Plantation, Florida, was sentenced by U.S. District Judge Robert N. Scola, Jr. in the Southern District of Florida. In addition to the prison term, Kushner was ordered to serve three years of supervised release.
Kushner was convicted on August 24, 2012, of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, following a two-month jury trial.
According to the evidence at trial, Kushner and his co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP)—a form of intensive treatment for severe mental illness. Instead of providing legitimate PHP services, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or were not properly reimbursable by Medicare. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.
The evidence at trial further showed that, as Biscayne Milieu’s medical director, Kushner authorized the treatment of patients that he knew were ineligible for PHP treatment. Biscayne Milieu then billed Medicare for millions of dollars in PHP treatments for these patients under Kushner’s name. Evidence further revealed that Kushner would often conduct cursory examinations lasting only minutes before authorizing such fraudulent billings.
Various owners, doctors, managers, therapists, patient brokers, and other employees of Biscayne Milieu have also been charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed in September 2011 and May 2012. Biscayne Milieu, its owners, and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial. Antonio and Jorge Macli and Sandra Huarte—the owners and operators of Biscayne Milieu—were each convicted at trial of various offenses and are scheduled for sentencing in April 2013.
This case is being prosecuted by Assistant U.S. Attorneys Michael Davis, Marlene Rodriguez and James V. Hayes of the U.S. Attorney’s Office for the Southern District of Florida; James V. Hayes was formerly a Trial Attorney in the Criminal Division’s Fraud Section. The case was investigated by the FBI with the assistance of HHS-OIG and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with the Medicare Fraud Strike Force, supervised by 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 1,480 defendants who have collectively billed the Medicare program for more than $4.8 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.

Two Medicare Beneficiaries Found Guilty of Soliciting Kickbacks in Home Health Care Case

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, Antonio J. Gomez, Postal Inspector in Charge of the U.S. Postal Inspection Service; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), inform that a federal jury found defendants Rene Suarez-Basanta, 67 years of age, and Marta Gonzalez, also 67 years of age, guilty of charges related to Medicare fraud.
The conviction of the defendants stemmed from the investigation of Safe Home Health Care Inc., a home health agency in Miami that was offering and paying kickbacks to obtain beneficiaries to serve as patients for home health services, mostly physical therapy. Conspirators at the agency used the beneficiary information to bill Medicare. Defendants Suarez-Basanta and Gonzalez were convicted of conspiring to pay and receive kickbacks. Defendant Gonzalez was also convicted of two additional counts for soliciting and accepting kickbacks in exchange for serving as a patient of Safe Home Health Care Inc. and having her parents serve as patients of Safe Home. In addition to be patients recruiters, Suarez-Basanta and Gonzalez are Medicare beneficiaries.
In total, nine defendants have been convicted of paying and receiving health care kickbacks in this investigation. Defendants Suarez-Basanta and Gonzalez are scheduled to be sentenced on May 25, 2013, at 10:00 a.m., before United States District Judge Ursula Ungaro, in Miami.
Mr. Ferrer commended the investigative efforts of the Federal Bureau of Investigation, U.S. Postal Inspection Service and the Office of the Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Eric Morales.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls.

Substance Abuse Counselor Pleads Guilty to Federal Health Care Fraud Charge

David B. Fein, United States Attorney for the District of Connecticut, announced that Alan Emmett Bradley, 57, of Norwalk, Connecticut, and Ocoee, Florida, pleaded guilty today before United States District Judge Vanessa L. Bryant in Hartford to one count of health care fraud.
According to court documents and statements made in court, Bradley, a certified alcohol and drug abuse counselor, obtained the Medicaid identification numbers of various Medicaid clients and used the identification numbers to submit hundreds of claims to Connecticut’s Department of Social Services. The claims alleged that Bradley performed 75- to 80-minute individual psychotherapy sessions to these Medicaid clients at his office in Norwalk. Hundreds of these counseling sessions did not occur and, for many of them, Bradley was actually living and attending school in Florida.
The Connecticut Medicaid program is a joint federal-state program designed primarily to finance the provision of medical services to the indigent. It is administered in Connecticut by the Department of Social Services and is also supervised by the federal Centers for Medicare and Medicaid Service.
Through this scheme, Bradley defrauded the Connecticut Medicaid program of $151,898.75.
Bradley was arrested in Florida on May 17, 2012. He has been detained since November 29, 2012, after he was found to have violated certain conditions of his pretrial release.
Judge Bryant has scheduled sentencing for June 5, 2013, at which time Bradley faces a maximum term of imprisonment of 10 years and a fine of up to $250,000.
This matter is being investigated by the U.S. Department of Health and Human Services-Office of Inspector General and the Federal Bureau of Investigation. The case is being prosecuted by Special Assistant United States Attorney Michael Ahearn, Assistant United States Attorney David Sheldon, and Auditor Kevin Saunders.
U.S. Attorney Fein encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force at 203-777-6311 or 1-800-HHS-TIPS.

Armenian National Sentenced to 41 Months in Prison for Role in Health Care Fraud Conspiracy

BRUNSWICK, GA—Khoren Gasparian, 30, an Armenian national, was sentenced last Friday by Chief United States District Court Judge Lisa Godbey Wood to 41 months in prison for his role in a conspiracy to defraud Medicare through phony medical businesses in Savannah, Georgia.
Gasparian, who at the time of these offenses was in the United States on an expired visa from Armenia, previously pleaded guilty to a conspiracy to defraud Medicare. According to the evidence presented at Gasparian’s guilty plea and sentencing hearings:
From 2008 through 2010, Gasparian and others opened medical equipment companies in Savannah, Georgia, known as Healthy Family, SOJ Group, and Savana Medical. Once opened, Gasparian and his cohorts stole the identities of hundreds of Medicare beneficiaries; stole the identities of dozens of doctors; and used this stolen information to submit hundreds of thousands of dollars in phony claims to Medicare for health care services that were never provided. Gasparian and others used the stolen identities of doctors and patients from multiple different states, including Alaska, California, New York, and Ohio and even submitted claims for people that were dead at the time they were alleged to have been provided medical equipment. Gasparian was also connected with at least two other phony health care businesses located in California and New Mexico. He was responsible for approximately $1 million worth of fraudulent claims submitted to Medicare.
United States Attorney Edward J. Tarver said, “Medicare fraud affects every American taxpayer. The United States Attorney’s Office has aggressively pursued healthcare fraudsters from around the world who’ve attempted to set up shop here in the Southern District of Georgia. The risk of detection is high for those who submit fraudulent claims to Medicare and the penalty will be substantial.”
“Criminals who steal from federal health care programs and taxpayers will be prosecuted to the fullest extent of the law,” 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. “The Office of Inspector General and our law enforcement partners will continue to aggressively pursue these thieves to ensure they are held accountable.”
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI will continue to work with its various law enforcement partners to identify, investigate, and bring forward for prosecution those individuals such as Mr. Gasparian who would steal funds from much needed federal programs such as Medicare.”
In addition to being sentenced to 41 months in prison, Gasparian was ordered to pay restitution in the amount of $182,735 and to serve three years of supervised release upon completion of his prison sentence. There is no parole in the federal system. At the time of his guilty plea in Georgia, Gasparian was serving a prison sentence based on his guilty plea to a health care fraud offense in the United States District Court for the District of New Mexico. After Gasparian finishes serving his prison sentences, he will face immigration proceedings that will likely result in his deportation to Armenia.
The prosecution of Gasparian in the Southern District of Georgia is part of a multi-jurisdictional investigation involving more than $200 million worth of phony claims submitted to Medicare. More than 35 defendants were arrested as part of this investigation. In addition to the Southern District of Georgia, numerous charges were filed in New York, Los Angeles, Cleveland, and Albuquerque.
The investigation in the Southern District of Georgia was the result of a multi-agency team of federal, state, and local agents, led by the Federal Bureau of Investigation (FBI), the Department of Health and Human Services-Office of the Inspector General (HHS/OIG), and Immigration and Customs Enforcement (ICE), working together to combat health care fraud. Assistant United States Attorney Brian T. Rafferty 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.

Owner and Operator of Houston-Area Ambulance Service Convicted in Medicare Fraud Scheme

WASHINGTON—The owner and operator of a Houston-area ambulance company was convicted by a federal jury in Houston of multiple counts of health care fraud for submitting false and fraudulent claims to Medicare, Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, and Special Agent in Charge Mike Fields of the U.S. Health and Human Services Office of Inspector General-Office of Investigations Houston Office announced today.
Olusola Elliott, 44, of Fort Bend County, Texas, was convicted late yesterday by a federal jury in U.S. District Court in the Southern District of Texas of one count of conspiracy to commit health care fraud and six counts of health care fraud.
Elliott was the owner and operator of Double Daniels LLC, a Texas entity that purportedly provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. According to evidence presented at trial, Elliott and others conspired from April 2010 through December 2011 to unlawfully enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and not provided. Evidence showed that Elliott falsified patient records in order to fraudulently bill Medicare on behalf of beneficiaries who were not in need of ambulance services.
During the course of the scheme, Elliott submitted and caused the submission of approximately $1,713,716 in fraudulent ambulance service claims to Medicare. According to court documents, Elliot transferred the proceeds of the fraud to himself and others after Medicare payments were sent to Double Daniels.
Elliot is scheduled for sentencing on May 31, 2013, in Houston. The six health care fraud counts and the conspiracy count each carry a maximum potential penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section, with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG, and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and 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 1,480 defendants who have collectively billed the Medicare program for more than $4.8 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.

Owner and Operator of Houston-Area Ambulance Service Convicted in Medicare Fraud Scheme

WASHINGTON—The owner and operator of a Houston-area ambulance company was convicted by a federal jury in Houston of multiple counts of health care fraud for submitting false and fraudulent claims to Medicare, Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, and Special Agent in Charge Mike Fields of the U.S. Health and Human Services Office of Inspector General-Office of Investigations Houston Office announced today.
Olusola Elliott, 44, of Fort Bend County, Texas, was convicted late yesterday by a federal jury in U.S. District Court in the Southern District of Texas of one count of conspiracy to commit health care fraud and six counts of health care fraud.
Elliott was the owner and operator of Double Daniels LLC, a Texas entity that purportedly provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. According to evidence presented at trial, Elliott and others conspired from April 2010 through December 2011 to unlawfully enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and not provided. Evidence showed that Elliott falsified patient records in order to fraudulently bill Medicare on behalf of beneficiaries who were not in need of ambulance services.
During the course of the scheme, Elliott submitted and caused the submission of approximately $1,713,716 in fraudulent ambulance service claims to Medicare. According to court documents, Elliot transferred the proceeds of the fraud to himself and others after Medicare payments were sent to Double Daniels.
Elliot is scheduled for sentencing on May 31, 2013, in Houston. The six health care fraud counts and the conspiracy count each carry a maximum potential penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section, with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG, and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and 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 1,480 defendants who have collectively billed the Medicare program for more than $4.8 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.

Nelson County Drug Store Owner Charged with Health Care Fraud and Wire Fraud

LOUISVILLE, KY—The owner of Crume Drug Store, located in Nelson County, Kentucky, was charged in United States District Court this week in a two-count federal information with wire fraud and billing private insurance companies and Medicare Part D for fraudulent prescriptions, announced David J. Hale, United States Attorney for the Western District of Kentucky.
According to the federal charges, Timothy Sizemore, age 36, of Bardstown, Kentucky, knowingly devised and executed a scheme between April 2010 and February 2012 whereby he used patients’ and doctors’ names to create fraudulent prescriptions and billed Anthem and other private insurance companies for those fraudulent prescriptions, even though those prescriptions were never actually filled. Further, it is alleged that during the same time period, Sizemore used patients’ and doctors’ names to create fraudulent prescriptions and billed Medicare Part D for those fraudulent prescriptions which were never filled.
If convicted at trial, Sizemore could be face no more than 30 years in prison, a fine of $500,000, and three years of supervised release. An initial appearance on the charges has not been scheduled.
This case is being prosecuted by Assistant United States Attorney David Weiser and is being investigated by the Federal Bureau of Investigation (FBI) and U.S. Department of Health and Human Services Office of Inspector General.

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The indictment of a person by a grand jury is an accusation only and that person is presumed innocent until and unless proven guilty.